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 2: Nonsuperficial (deep) soft tissue mass. Initial imaging. 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. Radiography Area of Interest Initial imaging assessment of a suspected musculoskeletal soft tissue mass should almost invariably begin with radiographic evaluation and is advocated by ESMO-EURACAN [9]. Radiographs remain the modality best suited for the initial assessment of a suspected soft tissue mass and are the initial study of choice for orthopedic oncologists [25,26]. However, radiographs have limitations and may not reveal an abnormality when a mass is small, deep- seated, nonmineralized, or in an area with complex anatomy such as the flank, paraspinal region, groin, or deep soft tissues of the hands and feet [11]. US Area of Interest The diagnostic accuracy of US is considerably less when lesions outside the subcutaneous tissue are included. It is also less reliable for defining deep masses in large anatomical areas [27]. Although a recent prospective study of US accuracy in the characterization of 134 histologically proven deep soft tissue masses showed promising results, there were only a small number of malignancies in the study cohort, and the investigators had a high level of US expertise [28]. Therefore, US is most appropriate for superficial masses that are small (<5 cm) in size [13] but may be appropriate for deep soft tissue masses in specific settings, such as a deep mass in a thin patient.
Soft Tissue Masses. 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 2: Nonsuperficial (deep) soft tissue mass. Initial imaging. 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. Radiography Area of Interest Initial imaging assessment of a suspected musculoskeletal soft tissue mass should almost invariably begin with radiographic evaluation and is advocated by ESMO-EURACAN [9]. Radiographs remain the modality best suited for the initial assessment of a suspected soft tissue mass and are the initial study of choice for orthopedic oncologists [25,26]. However, radiographs have limitations and may not reveal an abnormality when a mass is small, deep- seated, nonmineralized, or in an area with complex anatomy such as the flank, paraspinal region, groin, or deep soft tissues of the hands and feet [11]. US Area of Interest The diagnostic accuracy of US is considerably less when lesions outside the subcutaneous tissue are included. It is also less reliable for defining deep masses in large anatomical areas [27]. Although a recent prospective study of US accuracy in the characterization of 134 histologically proven deep soft tissue masses showed promising results, there were only a small number of malignancies in the study cohort, and the investigators had a high level of US expertise [28]. Therefore, US is most appropriate for superficial masses that are small (<5 cm) in size [13] but may be appropriate for deep soft tissue masses in specific settings, such as a deep mass in a thin patient.