The Utility of Chest Imaging for Surveillance of Atypical Lipomatous Tumors.

Alexander L Lazarides,Zachary D C Burke,Harrison R Ferlauto,Bruce D Leckey,Brian E Brigman,Julia D Visgauss,Jay S Wunder,William C Eward,Nicholas M Bernthal,Anthony M Griffin,Peter C Ferguson,Manish Agarwal

doi:10.1155/2021/4740924

Alexander L Lazarides, Zachary D C Burke + Show 10 more

Open Access

https://doi.org/10.1155/2021/4740924

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Abstract

Background Unlike other soft tissue sarcomas, atypical lipomatous tumors (ALTs) are thought to have a low propensity for metastasis. Despite this, a standard of care for pulmonary metastasis (PM) surveillance has not been established. This study aimed to evaluate the utility of chest imaging for PM surveillance following ALT excision. Methods This was a multi-institution, retrospective review of all patients with primary ALTs of the extremities or superficial torso who underwent excision between 2006 and 2018. Minimum follow-up was two years. Long-term survival was evaluated using the Kaplan–Meier method. Results 190 patients with ALT were included. Average age was 61.7 years and average follow-up was 58.6 months (24 to 180 months). MDM2 testing was positive in 88 patients (46.3%), and 102 (53.7%) did not receive MDM2 testing. 188 patients (98.9%) had marginal excision, and 127 (66.8%) had marginal or positive margins. Patients received an average of 0.9 CT scans and 1.3 chest radiographs over the surveillance period. 10-year metastasis-free survival was 100%, with no documented deaths from disease. Conclusions This study suggests that chest imaging does not have a significant role in PM surveillance following ALT excision, but advanced local imaging and chest surveillance may be considered in cases of local recurrence or concern for dedifferentiation.

Highlights

Adipocytic neoplasms comprise a spectrum of soft tissue tumors ranging from benign lipomas to high-grade liposarcomas [1]
If the pulmonary disease observed in this patient did, represent metastatic lesions, it is important to note that imaging of the primary tumor was highly concerning for dedifferentiation. us, it may be reasonable to extrapolate that while the findings in this study suggest that chest surveillance may be overutilized in primary atypical lipomatous tumors (ALTs), clinicians should assess the need for pulmonary metastasis (PM) surveillance in the setting of clinical concern for dedifferentiation
For ALTs, the utility of chest imaging for surveillance of PM has not been well defined

Summary

Introduction

Adipocytic neoplasms comprise a spectrum of soft tissue tumors ranging from benign lipomas to high-grade liposarcomas [1]. Within this spectrum exists a low-grade adipocytic neoplasm that, prior to 1979, was known as a well differentiated liposarcoma (WDL) [2]. Despite being genetically, histologically, and grossly identical to WDLs of the retroperitoneum, WDLs of the extremities and superficial torso are referred to as atypical lipomatous tumors (ALTs). The recent identification of amplification of the MDM2 oncogene in ALTs has facilitated accurate differentiation from benign lipomas. Despite a propensity for local recurrence, metastasis is extremely rare and is thought to occur in

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