A retrospective single-institution study of 11 local recurrences in 124 patients with soft tissue sarcoma found MRI had a positive predictive value of only 42% with 11 false-positive examinations in this cohort and advocated for clinical surveillance only [83]. However, the Park et al [77] larger single-institution studies found a positive predictive value of 93%. 12 Malignant or Aggressive Primary Musculoskeletal Tumor Postcontrast imaging has been shown to add benefit in evaluation of soft tissue tumors to differentiate benign versus malignant lesions [68]. A more recent retrospective study assessing the added value of postcontrast MRI showed contrast improved reader confidence even for experienced readers and improved accuracy of a more inexperienced reader from 65% to 72% [67]. However, MRI without IV contrast is still highly sensitive in detecting local recurrence of soft tissue tumor because of an inherent soft tissue contrast of MRI and therefore is still of benefit. Radiography Area of Interest In rare instances of a primary soft tissue tumor that produces osseous or chondroid matrix, there may be limited benefit of radiography area of interest for detecting local recurrence, but in general this modality is usually not helpful for most patients. There is no relevant literature to support the use of radiography alone as surveillance for local recurrence of malignant or aggressive primary soft tissue tumors. US Area of Interest Local recurrence of a soft tissue tumor can be detected with US. Note that most studies comparing US with MRI are outdated because both US and MRI technology have advanced significantly.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. A retrospective single-institution study of 11 local recurrences in 124 patients with soft tissue sarcoma found MRI had a positive predictive value of only 42% with 11 false-positive examinations in this cohort and advocated for clinical surveillance only [83]. However, the Park et al [77] larger single-institution studies found a positive predictive value of 93%. 12 Malignant or Aggressive Primary Musculoskeletal Tumor Postcontrast imaging has been shown to add benefit in evaluation of soft tissue tumors to differentiate benign versus malignant lesions [68]. A more recent retrospective study assessing the added value of postcontrast MRI showed contrast improved reader confidence even for experienced readers and improved accuracy of a more inexperienced reader from 65% to 72% [67]. However, MRI without IV contrast is still highly sensitive in detecting local recurrence of soft tissue tumor because of an inherent soft tissue contrast of MRI and therefore is still of benefit. Radiography Area of Interest In rare instances of a primary soft tissue tumor that produces osseous or chondroid matrix, there may be limited benefit of radiography area of interest for detecting local recurrence, but in general this modality is usually not helpful for most patients. There is no relevant literature to support the use of radiography alone as surveillance for local recurrence of malignant or aggressive primary soft tissue tumors. US Area of Interest Local recurrence of a soft tissue tumor can be detected with US. Note that most studies comparing US with MRI are outdated because both US and MRI technology have advanced significantly.