Image-Guided Fine Needle Aspiration Area of Interest The literature does not support the use of image-guided fine needle aspiration as the next step in evaluation following nondiagnostic radiographs or US of a soft tissue mass. At least 20% to 25% of soft tissue masses can demonstrate features that allow for confident diagnosis based on MRI alone [23], many of which are benign and Soft Tissue Masses thus would not warrant biopsy. Therefore, diagnostic imaging that includes comprehensive characterization of the mass should routinely be performed before biopsy. In fact, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Soft Tissue Sarcoma state that biopsy should be performed only after adequate imaging [24]. US Area of Interest With IV Contrast Although prospective studies have emerged suggesting that US is accurate in the discrimination of benign from malignant soft tissue masses, the number of malignancies in these studies was limited [16,28]. Therefore, the use of US for the final evaluation and staging of a deep soft tissue mass is not recommended. Variant 4: Soft tissue mass. Nondiagnostic radiograph and noncontrast-enhanced ultrasound. MRI contraindicated. Next imaging study. The body regions covered in this clinical scenario include the neck, chest, abdomen, pelvis, humerus/upper arm, shoulder, elbow, forearm, wrist, hand, hip, femur/thigh, knee, tibia/lower leg, ankle, and foot. CT Area of Interest With IV Contrast CT has become a useful technique for the evaluation of patients who cannot undergo MRI and is the modality of choice in this scenario [29]. In the evaluation of suspected tumors, contrast imaging is especially useful in distinguishing vascularized from potentially necrotic regions of the tumor. With modern CT technology, calcification can usually be distinguished from vascular enhancement. Of note, dual-energy CT is a relatively newer technology that has shown utility in evaluation of soft tissue masses.
Soft Tissue Masses. Image-Guided Fine Needle Aspiration Area of Interest The literature does not support the use of image-guided fine needle aspiration as the next step in evaluation following nondiagnostic radiographs or US of a soft tissue mass. At least 20% to 25% of soft tissue masses can demonstrate features that allow for confident diagnosis based on MRI alone [23], many of which are benign and Soft Tissue Masses thus would not warrant biopsy. Therefore, diagnostic imaging that includes comprehensive characterization of the mass should routinely be performed before biopsy. In fact, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Soft Tissue Sarcoma state that biopsy should be performed only after adequate imaging [24]. US Area of Interest With IV Contrast Although prospective studies have emerged suggesting that US is accurate in the discrimination of benign from malignant soft tissue masses, the number of malignancies in these studies was limited [16,28]. Therefore, the use of US for the final evaluation and staging of a deep soft tissue mass is not recommended. Variant 4: Soft tissue mass. Nondiagnostic radiograph and noncontrast-enhanced ultrasound. MRI contraindicated. Next imaging study. The body regions covered in this clinical scenario include the neck, chest, abdomen, pelvis, humerus/upper arm, shoulder, elbow, forearm, wrist, hand, hip, femur/thigh, knee, tibia/lower leg, ankle, and foot. CT Area of Interest With IV Contrast CT has become a useful technique for the evaluation of patients who cannot undergo MRI and is the modality of choice in this scenario [29]. In the evaluation of suspected tumors, contrast imaging is especially useful in distinguishing vascularized from potentially necrotic regions of the tumor. With modern CT technology, calcification can usually be distinguished from vascular enhancement. Of note, dual-energy CT is a relatively newer technology that has shown utility in evaluation of soft tissue masses.