Lipomatous Soft Tissue Masses: Challenging the Paradigm of Routine Preoperative Biopsy
| Autor: | Junko Ozao-Choy, Christine Dauphine, Kathryn T. Chen, Vikas Satyananda, Natalie C. McClintock, Danielle M. Hari |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Radiography Soft Tissue Neoplasms Liposarcoma Malignancy Atypical Lipomatous Tumor Diagnosis Differential Surgical pathology 03 medical and health sciences 0302 clinical medicine Preoperative Care Biopsy medicine Humans Retrospective Studies medicine.diagnostic_test business.industry Soft tissue Middle Aged Lipoma medicine.disease Magnetic Resonance Imaging Tumor Burden 030220 oncology & carcinogenesis Practice Guidelines as Topic Female 030211 gastroenterology & hepatology Surgery Biopsy Large-Core Needle Radiology business |
| Zdroj: | Journal of Surgical Research. 247:103-107 |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2019.10.037 |
| Popis: | Background Lipomatous masses are the most common soft tissue tumors. While the majority are benign lipomas, it is important to identify those masses that are malignant prior to excision. Current guidelines recommend core needle biopsy (CNB) for all lipomatous masses larger than 3-5 cm. The objective of this study was to determine if routine preoperative CNB based on mass size is necessary, or if radiographic features can guide the need for CNB. Materials and methods Patients who underwent excision of extremity or truncal lipomatous masses at a single institution from October 2014 to July 2017 were retrospectively reviewed. By protocol, preoperative imaging was routinely obtained for all masses larger than 5 cm. High-risk radiographic features (intramuscular location, septations, nonfat nodules, heterogeneity, and ill-defined margins) and surgical pathology were evaluated to determine patients most likely to benefit from preoperative CNB. Results Of 178 patients, 2 (1.1%) had malignant tumors on surgical pathology. All masses smaller than 5 cm were benign and, if imaging was obtained, had two or fewer high-risk radiographic features. Both of the patients with malignant tumors had masses larger than 5 cm, preoperative imaging that showed at least four high-risk radiographic features, and underwent CNB prior to excision. Conclusions The overall rate of malignancy is very low. The results of this study suggest that lipomatous masses smaller than 5 cm without concerning clinical characteristics do not require preoperative imaging or CNB. Conversely, lipomatous masses larger than 5 cm should undergo routine MRI with subsequent CNB if multiple high-risk radiographic features are present. |
| Databáze: | OpenAIRE |
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