The same group of researchers had similar results in an earlier separate retrospective analysis of 247 histologically proven masses [17]. However, although these results highlight the benefits of US in the initial assessment of superficial masses, the overall number of malignancies in both the prospective [16] and retrospective [17] studies was very small (12 patients and 11 patients, respectively). Another recent study of 42 histologically proven masses concluded that MRI performed after US does not frequently change the working diagnosis or add diagnostic value, but again, this study only included a small number of malignancies and the value of MRI for these malignancies was not separately addressed in the study [18]. Therefore, we emphasize that these studies do not have sufficient power for showing high accuracy of US in the diagnosis of malignancy. Ultimately, US is most beneficial for triage, and when US features are not clearly benign or when history and physical examination findings are otherwise concerning, further imaging is required [9,19]. US Area of Interest With IV Contrast The use of intravenous (IV) contrast during US evaluation of soft tissue tumors may add further confidence in discriminating benign from indeterminate or malignant masses [20-22]. However, there is no literature showing that the addition of contrast provides a gain in diagnostic accuracy over standard grayscale and Doppler US features in the assessment of a soft tissue mass. Therefore, the literature does not support the use of US contrast in the initial examination of a superficial soft tissue mass. MRI Area of Interest Without and With IV Contrast There is insufficient literature to support the routine use of MRI without or with IV contrast as the initial examination for a soft tissue mass. The inherent limitations of this modality, most notably in the identification of mineralization, limit its use in isolation.
Soft Tissue Masses. The same group of researchers had similar results in an earlier separate retrospective analysis of 247 histologically proven masses [17]. However, although these results highlight the benefits of US in the initial assessment of superficial masses, the overall number of malignancies in both the prospective [16] and retrospective [17] studies was very small (12 patients and 11 patients, respectively). Another recent study of 42 histologically proven masses concluded that MRI performed after US does not frequently change the working diagnosis or add diagnostic value, but again, this study only included a small number of malignancies and the value of MRI for these malignancies was not separately addressed in the study [18]. Therefore, we emphasize that these studies do not have sufficient power for showing high accuracy of US in the diagnosis of malignancy. Ultimately, US is most beneficial for triage, and when US features are not clearly benign or when history and physical examination findings are otherwise concerning, further imaging is required [9,19]. US Area of Interest With IV Contrast The use of intravenous (IV) contrast during US evaluation of soft tissue tumors may add further confidence in discriminating benign from indeterminate or malignant masses [20-22]. However, there is no literature showing that the addition of contrast provides a gain in diagnostic accuracy over standard grayscale and Doppler US features in the assessment of a soft tissue mass. Therefore, the literature does not support the use of US contrast in the initial examination of a superficial soft tissue mass. MRI Area of Interest Without and With IV Contrast There is insufficient literature to support the routine use of MRI without or with IV contrast as the initial examination for a soft tissue mass. The inherent limitations of this modality, most notably in the identification of mineralization, limit its use in isolation.