When hardware is present, even with modern metal-artifact reduction techniques, radiography can visualize the bone-metal or bone-cement interface, which can be critical to evaluate for tumor recurrence. Radiographs are recommended for the surveillance of local recurrence of malignant or aggressive primary bone tumors. US Area of Interest US is not useful for evaluating bone lesions when there is no extraosseous tumor extension. However, US may be beneficial if a mass is identified clinically. There is no relevant literature to support the use of US as surveillance for asymptomatic local recurrence of malignant or aggressive primary bone tumors. Variant 5: Malignant or aggressive primary soft tissue tumor. Surveillance for local recurrence. The body regions covered in this clinical scenario are abdomen, ankle, chest, elbow, shoulder, thigh, foot, forearm, hand, arm, knee, pelvis, leg, and wrist. Local recurrence rates of soft tissue sarcomas have been reported to occur at rates of 5% to 25% in larger historic studies [69-72]. Although rates of local recurrence following primary resection depend on tumor histology and grade, several other factors have been identified that increase risk. Tumor location is associated with local recurrence, with those tumors located deep to fascia or in the upper extremities/trunk as more likely to recur [73]. Positive or close resection margins have also been associated with increased likelihood of local recurrence [70,73,74]. Local recurrence is associated with metastatic disease and increased mortality [70], and if the recurrence can be treated before developing metastatic disease there is a survival benefit [73]. Size of the recurrence has also been linked with not only survival [75] but also morbidity, because larger tumors often require more extensive surgery [48]. Therefore, surveillance for local recurrence is important to reduce both mortality and morbidity.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. When hardware is present, even with modern metal-artifact reduction techniques, radiography can visualize the bone-metal or bone-cement interface, which can be critical to evaluate for tumor recurrence. Radiographs are recommended for the surveillance of local recurrence of malignant or aggressive primary bone tumors. US Area of Interest US is not useful for evaluating bone lesions when there is no extraosseous tumor extension. However, US may be beneficial if a mass is identified clinically. There is no relevant literature to support the use of US as surveillance for asymptomatic local recurrence of malignant or aggressive primary bone tumors. Variant 5: Malignant or aggressive primary soft tissue tumor. Surveillance for local recurrence. The body regions covered in this clinical scenario are abdomen, ankle, chest, elbow, shoulder, thigh, foot, forearm, hand, arm, knee, pelvis, leg, and wrist. Local recurrence rates of soft tissue sarcomas have been reported to occur at rates of 5% to 25% in larger historic studies [69-72]. Although rates of local recurrence following primary resection depend on tumor histology and grade, several other factors have been identified that increase risk. Tumor location is associated with local recurrence, with those tumors located deep to fascia or in the upper extremities/trunk as more likely to recur [73]. Positive or close resection margins have also been associated with increased likelihood of local recurrence [70,73,74]. Local recurrence is associated with metastatic disease and increased mortality [70], and if the recurrence can be treated before developing metastatic disease there is a survival benefit [73]. Size of the recurrence has also been linked with not only survival [75] but also morbidity, because larger tumors often require more extensive surgery [48]. Therefore, surveillance for local recurrence is important to reduce both mortality and morbidity.