There is also debate concerning the frequency of lung surveillance. Given most pulmonary metastases will occur within 2 years of primary resection [47], many experts support more frequent surveillance initially in the first few years after diagnosis. Surveillance regimens usually de-escalate to annual follow-up after 5 years postresection [48-52]. Although these dynamic protocols are often used, a prospective randomized trial of 500 patients with resected extremity sarcomas and no baseline metastatic disease found no difference in overall survival or recurrence-free survival between groups whether surveilled at 3 month or 6-month consistent intervals [53,54]. Pulmonary metastases are associated with a worse prognosis [45], and treatment of these pulmonary metastases can improve survival [8,10]. Identification of pulmonary metastases is an essential part of primary musculoskeletal tumor screening. There is little to no variation in the ability of a certain modality to detect pulmonary metastasis whether performed at initial staging (see Variant 1), surveillance, or restaging in the setting of recurrence. 7 Malignant or Aggressive Primary Musculoskeletal Tumor CT Chest With IV Contrast There is no relevant literature regarding the specific use of CT chest with IV contrast in the evaluation of pulmonary metastasis from malignant or aggressive primary musculoskeletal tumors. However, IV contrast may lead to equivocal assessment of mineralization, which can be a useful morphologic feature to distinguish benign versus malignant pulmonary nodules. Therefore, CT chest with IV contrast is not generally useful as the sole imaging technique, and there is felt to be little additional benefit in the CT assessment of pulmonary nodules without and with IV contrast compared to CT chest without IV contrast in this setting.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. There is also debate concerning the frequency of lung surveillance. Given most pulmonary metastases will occur within 2 years of primary resection [47], many experts support more frequent surveillance initially in the first few years after diagnosis. Surveillance regimens usually de-escalate to annual follow-up after 5 years postresection [48-52]. Although these dynamic protocols are often used, a prospective randomized trial of 500 patients with resected extremity sarcomas and no baseline metastatic disease found no difference in overall survival or recurrence-free survival between groups whether surveilled at 3 month or 6-month consistent intervals [53,54]. Pulmonary metastases are associated with a worse prognosis [45], and treatment of these pulmonary metastases can improve survival [8,10]. Identification of pulmonary metastases is an essential part of primary musculoskeletal tumor screening. There is little to no variation in the ability of a certain modality to detect pulmonary metastasis whether performed at initial staging (see Variant 1), surveillance, or restaging in the setting of recurrence. 7 Malignant or Aggressive Primary Musculoskeletal Tumor CT Chest With IV Contrast There is no relevant literature regarding the specific use of CT chest with IV contrast in the evaluation of pulmonary metastasis from malignant or aggressive primary musculoskeletal tumors. However, IV contrast may lead to equivocal assessment of mineralization, which can be a useful morphologic feature to distinguish benign versus malignant pulmonary nodules. Therefore, CT chest with IV contrast is not generally useful as the sole imaging technique, and there is felt to be little additional benefit in the CT assessment of pulmonary nodules without and with IV contrast compared to CT chest without IV contrast in this setting.