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 thus would not warrant biopsy. Therefore, diagnostic imaging that includes comprehensive characterization of the mass should routinely be performed before biopsy. In fact, the Soft Tissue Masses National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Soft Tissue Sarcoma state that biopsy should be performed only after adequate imaging [24]. Image-Guided Fine Needle Aspiration Area of Interest The literature does not support the use of image-guided fine needle aspiration as the initial examination for 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 thus would not warrant fine needle aspiration. 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 or fine needle aspiration should be performed only after adequate imaging [24]. Variant 3: Soft tissue mass. Nondiagnostic radiograph and noncontrast-enhanced ultrasound. 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. Of note, this variant addresses the scenario in which radiographs and/or noncontrast US have been performed but did not sufficiently characterize a soft tissue mass. In addition, this variant presumes there are no contraindications to any imaging modality. Variant 4 specifically addresses the situation of a contraindication to MRI.
Soft Tissue Masses. 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 thus would not warrant biopsy. Therefore, diagnostic imaging that includes comprehensive characterization of the mass should routinely be performed before biopsy. In fact, the Soft Tissue Masses National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Soft Tissue Sarcoma state that biopsy should be performed only after adequate imaging [24]. Image-Guided Fine Needle Aspiration Area of Interest The literature does not support the use of image-guided fine needle aspiration as the initial examination for 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 thus would not warrant fine needle aspiration. 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 or fine needle aspiration should be performed only after adequate imaging [24]. Variant 3: Soft tissue mass. Nondiagnostic radiograph and noncontrast-enhanced ultrasound. 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. Of note, this variant addresses the scenario in which radiographs and/or noncontrast US have been performed but did not sufficiently characterize a soft tissue mass. In addition, this variant presumes there are no contraindications to any imaging modality. Variant 4 specifically addresses the situation of a contraindication to MRI.