There remains some controversy not only on how to surveil resected soft tissue sarcomas but also if imaging surveillance is even necessary. The primary dispute against the need for imaging surveillance is the argument that recurrences are usually clinically detectable [54,76]. The literature also has some conflicting evidence on this topic. For example, a prospective study of 500 patients with sarcoma found 90% of local recurrences were clinically detected [54]. Conversely, a large recent study of 325 patients with soft tissue sarcomas found a rate of 60% of the local recurrences were not detected clinically [77]. Expert guidelines vary on recommendations for local recurrence imaging, although all acknowledge the benefit of clinical evaluation; some guidelines recommend clinical examination to be performed solely, whereas others recommend in combination with imaging [49,51,52,63]. Clinical evaluation of deep soft tissue local recurrence remains a limitation of this approach. Most local recurrences of soft tissue sarcomas occur within 5 years of primary resection [78]. Therefore, those guidelines that recommend imaging usually advocate for more aggressive imaging in the first 5 years that taper off to annual imaging. Tumor histology, grade, and clinical scenario remain paramount when deciding how to surveil for local recurrence. CT Area of Interest With IV Contrast CT remains useful for surveillance of local recurrence when MRI is unable to be obtained. CT imaging can also be of benefit if metal artifact on MRI cannot be resolved, although it should be noted CT is also susceptible to artifact from metal hardware. When evaluating the soft tissues, postcontrast imaging is recommended to increase the conspicuity of enhancing tumors and, if so, areas of necrosis that can help with biopsy planning and to serve as a baseline for future therapy response assessment.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. There remains some controversy not only on how to surveil resected soft tissue sarcomas but also if imaging surveillance is even necessary. The primary dispute against the need for imaging surveillance is the argument that recurrences are usually clinically detectable [54,76]. The literature also has some conflicting evidence on this topic. For example, a prospective study of 500 patients with sarcoma found 90% of local recurrences were clinically detected [54]. Conversely, a large recent study of 325 patients with soft tissue sarcomas found a rate of 60% of the local recurrences were not detected clinically [77]. Expert guidelines vary on recommendations for local recurrence imaging, although all acknowledge the benefit of clinical evaluation; some guidelines recommend clinical examination to be performed solely, whereas others recommend in combination with imaging [49,51,52,63]. Clinical evaluation of deep soft tissue local recurrence remains a limitation of this approach. Most local recurrences of soft tissue sarcomas occur within 5 years of primary resection [78]. Therefore, those guidelines that recommend imaging usually advocate for more aggressive imaging in the first 5 years that taper off to annual imaging. Tumor histology, grade, and clinical scenario remain paramount when deciding how to surveil for local recurrence. CT Area of Interest With IV Contrast CT remains useful for surveillance of local recurrence when MRI is unable to be obtained. CT imaging can also be of benefit if metal artifact on MRI cannot be resolved, although it should be noted CT is also susceptible to artifact from metal hardware. When evaluating the soft tissues, postcontrast imaging is recommended to increase the conspicuity of enhancing tumors and, if so, areas of necrosis that can help with biopsy planning and to serve as a baseline for future therapy response assessment.