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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. WHO Classification of Tumours Editorial Board. Soft tissue and bone tumours. 5th ed. Lyon (France): IARC Press; 2020. Review/Other-Dx N/A To provide an updated classification scheme and essential diagnostic criteria for soft tissue tumors. No results stated in abstract. 4
2. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Soft Tissue including Heart Cancer.  Available at: https://seer.cancer.gov/statfacts/html/soft.html. Observational-Dx N/A Statistical summaries and annually updated reports on trends in soft tissue including heart cancer statistics. No results stated in abstract. 4
3. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Bone and Joint Cancer.  Available at: https://seer.cancer.gov/statfacts/html/bones.html. Review/Other-Dx N/A Statistical summaries and annually updated reports on trends in bone and joint cancer statistics. No results stated in abstract. 4
4. Becher S, Oskouei S. PET Imaging in Sarcoma. [Review]. Orthop Clin North Am. 46(3):409-15, xi, 2015 Jul. Review/Other-Dx N/A To evaluate the possible role of PET/CT in diagnosis and treatment of bone and soft tissue sarcomas of the extremities. No results stated in abstract. 4
5. Billingsley KG, Lewis JJ, Leung DH, Casper ES, Woodruff JM, Brennan MF. Multifactorial analysis of the survival of patients with distant metastasis arising from primary extremity sarcoma. Cancer 1999;85:389-95. Review/Other-Dx 230 patients To analyze patterns of metastatic disease and define prognostic factors for survival in a large group of patients followed prospectively at a single institution. Distant metastasis developed in 230 patients (23%). Median survival after distant metastasis was 11.6 months. The lungs were the first metastatic site in 169 patients (73%). Other first sites of metastasis included the skin and soft tissues of the head and neck, trunk, and extremities. There was no statistically significant difference in survival between patients with pulmonary and those with nonpulmonary metastatic disease. In multivariate analysis, resection of metastatic disease, the length of the disease free interval, the presence of a preceding local recurrence, and patient age > 50 years all were significant predictors of postmetastasis survival. 4
6. Liu F, Zhang Q, Zhou D, Dong J. Effectiveness of 18F-FDG PET/CT in the diagnosis and staging of osteosarcoma: a meta-analysis of 26 studies. BMC Cancer. 19(1):323, 2019 Apr 05. Meta-analysis 26 studies To investigate the effectiveness of 18F-FDG PET and PET/CT in the diagnosis, staging, recurrence and metastasis formation observations of osteosarcoma through systematic review followed by meta-analysis. All data from these articles, utilized in the quantitative analyses, showed after meta-analysis that when utilizing 18F-FDG PET or PET/CT it was better with a success rate of 90-100% for detecting primary lesions and distant metastases of patients with osteosarcoma. Similar results were also obtained for detecting lung and bone metastases in a subgroup analysis. Good
7. Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer 2009;115:1531-43. Review/Other-Dx 3,482 patients with osteosarcoma (SEER data base) To compare osteosarcoma incidence and survival in three age groups (0–24, 25–59, and 60–85+) by race, sex, calendar year, disease stage, pathology subtype, and anatomic site. There were large differences in incidence and survival rates by age. Osteosarcoma incidence in the youngest cases was greatest in the Other race designation, while it was greatest in Blacks and Whites in the middle age and elderly patients, respectively. There was a high percentage of osteosarcoma with Paget’s disease and osteosarcoma as a second or greater cancer among the elderly. Tumor site differences among age groups were noted. Survival rates varied by anatomic site and disease stage, and have not significantly improved from 1984 to 2004. 4
8. Briccoli A, Rocca M, Salone M, Guzzardella GA, Balladelli A, Bacci G. High grade osteosarcoma of the extremities metastatic to the lung: long-term results in 323 patients treated combining surgery and chemotherapy, 1985-2005. Surg Oncol 2010;19:193-9. Observational-Dx 323 patients To determine the role of role of lung metastasectomy. The 5 year overall survival was 37%. Final outcome was significantly related to presence or absence of metastasis, time of first relapse and presence of local recurrences. According to stage of the disease, the rate of a 5 year event-free survival (EFS) was 36% for patients with localized disease who later relapsed and 9% for patients with resectable lung metastases at presentation (p<0.0001). However, there were no differences in EFS between patients who underwent two or three thoracotomies and patients who had four or five thoracotomies (7.5 vs 18.7%, p=0.29). 4
9. Ciccarese F, Bazzocchi A, Ciminari R, et al. The many faces of pulmonary metastases of osteosarcoma: Retrospective study on 283 lesions submitted to surgery. Eur J Radiol. 84(12):2679-85, 2015 Dec. Observational-Dx 70 patients To analyze CT features of suspected lesions submitted to surgery to address its current accuracy and to investigate criteria for predicting histology. 234/283--82.7% Lesions were metastases; 143--61.1% were calcified; most metastases were nodular (201/234--85.9%), but in 33/234--14.1% other findings were detected (striae, consolidations, pleural plaques/masses, cavitations, ground glass opacities, irregular shapes, halo sign). Malignant lesions were more frequently calcified, larger, with progression over time--p<0.0001. Manual palpation identified 314 lesions, 248 metastatic--79.0%: CT missed 31/314--9.9% lesions, whereof 14/31--45.2% were metastases. 2
10. Diemel KD, Klippe HJ, Branseheid D. Pulmonary metastasetomy for osteosarcoma: is it justified? Recent Results Cancer Res 2009;179:183-208. Review/Other-Dx 1,800 patients To determine the utility of pulmonary metastasetomy for osteosarcoma. Survival rates between 30% and 40% also show a certain consistency in interdisciplinary studies, with a range from 11% to 63% in all studies. The main prognostic factor affecting survival is complete surgical remission (CSR). It shows high significance particularly in studies with large numbers of patients. Time of metastatic presentation, and number and localization of metastases show significance more infrequently. Our own series focusses on overall survival rate (48%) and the importance of CSR as a prognostic factor (p < .001). 4
11. Kayton ML, Huvos AG, Casher J, et al. Computed tomographic scan of the chest underestimates the number of metastatic lesions in osteosarcoma. J Pediatr Surg. 41(1):200-6; discussion 200-6, 2006 Jan. Observational-Dx 54 consecutive thoracotomies performed in 28 patients To determine if computed tomographic (CT) scanning underestimated the number of pulmonary metastases in patients with osteosarcoma. Computed tomographic scanning was performed a median of 20 days before thoracotomy (range, 1-85 days). Correlation between the number of lesions identified by CT and the number of metastases resected at surgery was poor, with a Kendall tau-b correlation coefficient of 0.45 (P < .001). In 19 (35%) of 54 thoracotomies, CT scanning underestimated the number of pathologically proven, viable and nonviable metastases found by the surgeon. Accounting for viable metastases only, correlation between the number of lesions identified by CT and the number of metastases resected at surgery was 0.50 (P < .001), and CT scanning underestimated the number of viable metastases present in 14 (26%) of 54 thoracotomies. Many lesions (32%) were pleural-based, but nearly half (47%) were 5 mm or deeper from the pleural surface of the lung. 2
12. Dudeck O, Zeile M, Andreou D, et al. Computed tomographic criteria for the discrimination of subcentimeter lung nodules in patients with soft-tissue sarcomas. Clin Imaging. 35(3):174-9, 2011 May-Jun. Review/Other-Dx 195 patients To identify criteria for nodule characterization on chest computed tomography in patients with soft tissue sarcomas. Benign lesions more frequently displayed complex shape and were of ground-glass density (P<.0001, respectively). In contrast, round shape and solid density were more frequently found in malignant lesions (P<.0001, respectively). 4
13. Piperkova E, Mikhaeil M, Mousavi A, et al. Impact of PET and CT in PET/CT studies for staging and evaluating treatment response in bone and soft tissue sarcomas. Clin Nucl Med. 34(3):146-50, 2009 Mar. Observational-Dx 93 patients with 204 F-18 FDG PET/CT studies To evaluate the impact of both F-18 FDG PET/CT and CT on initial staging, evaluating treatment response, and restaging the disease in the shortand long-term follow-up, focusing on the discrepancy between CT and PET portions. Sixteen studies for initial staging were concordant in 14 and discordant in 2 patients (48 lesions, 46 concordant, and 2 discordant). PET showed 97.2% sensitivity and 100% specificity versus 100% and 91.6% on CT. Regarding the other 3 groups, 498 lesions were detected; PET and CT were concordant in 436/498 (88%) and discordant in 62/498 (12%). In group II for ETR, PET and CT were concordant in 64/83 (77%) and discordant in 19/83(23%) studies-13 showed excellent to complete response on PET with partial response (PR) or stable disease (SD) on CT; 6 studies in PET showed PR versus SD or progression of disease (PD) on CT. In group III, for early restaging of disease 36/45 (80%) concordant and 9/45 (20%) discordant (3 showed excellent to complete response and 2 PR on PET versus CT SD, 3 PET PR versus CT PD, and 1 PET study showed PD while CT showed SD). In group IV, for long-term restaging, 49/60 (82%) were concordant and 11/60 (18%) were discordant; 9 PET studies were negative for active disease versus CT positive and 2 PET studies showed PD, CT was negative. PET alone showed 94.1% sensitivity and 94.6% specificity versus 97.2% and 63.5% for CT, 100% and 95.9% for PET/CT. 3
14. Roberge D, Vakilian S, Alabed YZ, Turcotte RE, Freeman CR, Hickeson M. FDG PET/CT in Initial Staging of Adult Soft-Tissue Sarcoma. Sarcoma 2012;2012:960194. Observational-Dx 109 patients To investigate the safety and utility of FDG in imaging of cancer patients. 98% of previously unresected primary tumors were FDG avid. PET scans were negative for distant disease in 91/109 cases. The negative predictive value was 89%. Fourteen PET scans were positive. Of these, 6 patients were already known to have metastases, 3 were false positives, and 5 represented new findings of metastasis (positive predictive value 79%). In total, 5 patients were upstaged by FDG-PET (4.5%). 3
15. London K, Stege C, Cross S, et al. 18F-FDG PET/CT compared to conventional imaging modalities in pediatric primary bone tumors. Pediatr Radiol. 42(4):418-30, 2012 Apr. Observational-Dx 314 lesions were detected in 86 scans. To compare hybrid FDG positron emission tomography/computed tomography (PET/CT) with conventional imaging (CI) modalities in detecting malignant lesions, predicting response to chemotherapy and diagnosing physeal involvement in pediatric primary bone tumors. Excluding lung lesions, PET/CT had higher sensitivity and specificity than CI (83%, 98% and 78%, 97%, respectively). In lung lesions, PET/CT had higher specificity than CI (96% compared to 87%) but lower sensitivity (80% compared to 93%). Higher initial SUV(max) and greater SUV(max) reduction on PET/CT after chemotherapy predicted a good response. 3
16. Cistaro A, Lopci E, Gastaldo L, Fania P, Brach Del Prever A, Fagioli F. The role of 18F-FDG PET/CT in the metabolic characterization of lung nodules in pediatric patients with bone sarcoma. Pediatr Blood Cancer. 59(7):1206-10, 2012 Dec 15. Observational-Dx 18 patients To identify the lowest nodule diameter and the SUV(max) capable of characterizing lung nodules in pediatric patients with bone sarcoma. Overall, 63 lung nodules with a mean diameter of 3.35?mm (range 1.2-39.8?mm) were investigated. (18) F-FDG PET was performed according to standard procedure using a hybrid PET/CT system and results were compared with histology and/or clinical/radiological follow-up. For each lesion, we evaluated SUV(max) , SUV(ratio) to the mediastinal blood pool and maximum nodule diameter. Of the 63 nodules, 32 proved to be benign and 31 malignant. On a visual basis, (18) F-FDG PET had an accuracy of 88.9%, a sensitivity of 90.3%, a specificity of 87.5%, a PPV of 87.5%, and a NPV of 90.3%. ROC curve analysis of SUV(max) for all nodules showed a value around 1 (>1.09) to be capable of differentiating metastases from benign lesions: sensitivity and specificity were 90.3% and 93.8%, respectively (accuracy 92.1%). Similar analysis revealed a cut-off value around 1 (>0.83) for SUV(ratio) (sensitivity and specificity were 90.3% and 90.6%, respectively) and a cut-off value of ca. 6?mm (>5.8?mm) for nodule diameter (sensitivity and specificity of 90.3% and 81.3%, respectively). 2
17. Platzek I, Beuthien-Baumann B, Schramm G, et al. FDG PET/MR in initial staging of sarcoma: Initial experience and comparison with conventional imaging. Clin Imaging. 42:126-132, 2017 Mar - Apr. Observational-Dx 29 patients To assess the feasibility of positron emission tomography/magnetic resonance imaging (PET/MR) with 18F-fluordeoxyglucose (FDG) for initial staging of sarcoma. T and M stage were identical for PET/MR and conventional modalities in all patients (?=1). N stage was identical for 28/29 patients (?=0.65). 3
18. Fuglo HM, Maretty-Nielsen K, Hovgaard D, Keller JO, Safwat AA, Petersen MM. Metastatic pattern, local relapse, and survival of patients with myxoid liposarcoma: a retrospective study of 45 patients. Sarcoma. 2013;2013:548628. Review/Other-Tx 45 patients To assess the metastatic pattern of the histological subtype myxoid liposarcoma with no or few round cells. 7 patients had distant metastases during the observation period. 2 patients had metastases at the time of diagnosis, while metastases occurred within 2.5 years in 4 patients, and in 1 patient 11.9 years after primary diagnosis. All metastases occurred at extrapulmonary sites. The first local relapse occurred within 3 years after surgery in 6 patients, in 1 patient after 4.0 years, and in 1 patient 7.7 years after surgery. The 5- and 10-year OS was 80% and 69%, respectively. Both the 5- and 10-year distant metastases-free survival was, respectively, 86%. The 5- and 10-year local relapse-free survival was, respectively, 83% and 80%. 4
19. Jha P, Frolich AM, McCarville B, et al. Unusual association of alveolar rhabdomyosarcoma with pancreatic metastasis: emerging role of PET-CT in tumor staging. Pediatr Radiol. 2010;40(8):1380-1386. Review/Other-Dx 8 patients To assess the occurrence of pancreatic metastases in alveolar rhabdomyosarcomas, increase awareness of this association and reassess current staging protocols. Pancreatic metastases occurred in 8 patients with alveolar rhabdomyosarcomas. 4 of these presented at diagnosis and 4 with disease recurrence. In recurrent disease, the duration between the diagnosis of the primary tumor and pancreatic metastases varied from 8 months to 6 years (mean +/- SD: 2.38 +/- 2.49 years). In all patients who received PET scans, pancreatic metastases showed a marked FDG-uptake, but had variable detectability with CT. Pancreatic metastases were not associated with certain primary tumor locations or presence of other metastases, mandating an evaluation of the pancreas in all cases of alveolar rhabdomyosarcomas. 4
20. Nishida Y, Tsukushi S, Urakawa H, et al. High incidence of regional and in-transit lymph node metastasis in patients with alveolar rhabdomyosarcoma. Int J Clin Oncol. 2014;19(3):536-543. Review/Other-Dx 44 patients To investigate the patterns of regional and distant metastasis in patients with rhabdomyosarcomas, particularly lymphatic route metastasis, and clarify the clinical factors that affect the pattern of metastasis. Of the 3 cases of local relapse, 2 were alveolar type and 1 was unknown. The 3 cases of in-transit metastasis were all alveolar type. Patients with alveolar type had a significantly high propensity for lymph node metastasis (P=0.027). Excluding the pleomorphic type, alveolar type was still a significant factor for lymph node metastasis (P=0.017). 4
21. Cotterill SJ, Ahrens S, Paulussen M, et al. Prognostic factors in Ewing's tumor of bone: analysis of 975 patients from the European Intergroup Cooperative Ewing's Sarcoma Study Group. J Clin Oncol 2000;18:3108-14. Review/Other-Dx 975 Patients To further elaborate on prognostic factors for Ewing's sarcoma of bone and to document improvements in relapse-free survival (RFS) and trends in local therapy over the study period (1977 to 1993). For the group with metastases, there was a trend for better survival for those with lung involvement compared with those with bone metastases or a combination of lung and bone metastases (P: <.0001). In the group of patients with no metastases at diagnosis, multivariate analysis demonstrated that site (axial v other), age-group (< 15 v > or = 15 years), and period of diagnosis had significant influence on RFS (all P: <.005). RFS was superior in the period after 1985 compared with the period before 1985 for nonmetastatic patients (45% v 60%, respectively; P: <.0001) and for metastatic patients (16% v 30%, respectively; P: =.016). Patients who relapsed within 2 years of diagnosis had a less favorable prognosis than patients who relapsed later (5-year survival after relapse, 4% v 23%, respectively; P: <. 0001). 4
22. Quartuccio N, Fox J, Kuk D, et al. Pediatric bone sarcoma: diagnostic performance of 18F-FDG PET/CT versus conventional imaging for initial staging and follow-up. AJR Am J Roentgenol. 204(1):153-60, 2015 Jan. Observational-Dx 64 patients To compare the diagnostic performance of (18)F-FDG PET/CT and conventional imaging for staging and follow-up of pediatric osteosarcoma and skeletal Ewing sarcoma. A total of 412 lesions were characterized by imaging in 64 patients (20, osteosarcoma; 44, Ewing sarcoma). For osteosarcoma patients PET/CT was available only at follow-up, where it proved more accurate than conventional imaging for the detection of bone lesions (accuracy, 95% vs 67% for CT and 86% for MRI) and complementary to CT in evaluating lung nodules (sensitivity, 84% vs 94%; specificity, 79% vs 71%) with diagnostic benefit in 18% of examinations. In patients with Ewing sarcoma, PET/CT tended to perform better during follow-up than at initial staging (accuracy, 85% vs 69%). For lung findings, PET/CT was more specific than CT but was less sensitive. The diagnostic benefit of PET/CT was greater at staging (28%) than during followup (9%). On a per-patient basis, PET/CT provided diagnostic benefit in 21 of 44 patients with Ewing sarcoma and nine of 20 patients with osteosarcoma at least once during clinical management. 3
23. Chang CY, Gill CM, Joseph Simeone F, et al. Comparison of the diagnostic accuracy of 99 m-Tc-MDP bone scintigraphy and 18 F-FDG PET/CT for the detection of skeletal metastases. Acta Radiol. 57(1):58-65, 2016 Jan. Observational-Dx 202 patients To compare the accuracy of Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) with bone scan for the detection of skeletal metastases. The sensitivity, specificity, and accuracy for detecting skeletal metastatic disease of FDG PET/CT were 97%, 98%, and 98%, respectively, and of bone scan were 83%, 98%, and 93%, respectively. The lesions that bone scan most commonly missed were located in the pelvis, spine, and sacrum. FDG PET/CT missed mostly lesions that were outside of the field of view, but in all of these cases the patient had additional sites of skeletal metastatic disease. Bone scan falsely identified six metastatic lesions and FDG PET/CT falsely identified three metastatic lesions. 2
24. Byun BH, Kong CB, Lim I, et al. Comparison of (18)F-FDG PET/CT and (99 m)Tc-MDP bone scintigraphy for detection of bone metastasis in osteosarcoma. Skeletal Radiol. 42(12):1673-81, 2013 Dec. Observational-Dx 206 patients To compare the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and (99 m)Tc-methylene diphosphonate bone scintigraphy (BS) for the detection of bone metastasis in osteosarcoma. The sensitivity, specificity, and diagnostic accuracy were 95, 98, and 98%, respectively, for PET/CT; 76, 97, and 96%, respectively, for BS; and 100, 96, and 97%, respectively, for PET/CT+BS in an examination-based analysis. Lesion-based analysis demonstrated that the sensitivity of PET/CT+BS (100%) was significantly higher than that of PET/CT (92%) or BS (74%) alone. BS detected significantly less bone metastases in the growth plate region than outside the growth plate region (22 vs. 77%). 3
25. Cook GJ, Houston S, Rubens R, Maisey MN, Fogelman I. Detection of bone metastases in breast cancer by 18FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions. J Clin Oncol 1998;16:3375-9. Observational-Dx 23 patients To compare 18FDG PET with 99mTc MDP bone scintigraphy in patients with skeletal metastases from breast cancer. 18FDG PET detected more lesions than 99mTc MDP scintigraphy (mean, 14.1 and 7.8 lesions, respectively; P < .01). However, 18FDG detected fewer bone metastases compared with 99mTc MDP scintigraphy in a subgroup of patients with osteoblastic disease (P < .05). Higher SUVs were observed for osteolytic than osteoblastic disease (mean, 6.77 and 0.95, respectively; P < .01). Survival was lower in patients with osteolytic disease compared with the remainder (P=.01). A difference in survival was not found for those patients with high SUVs (> 3.6; P=.4). 3
26. Gallowitsch HJ, Kresnik E, Gasser J, et al. F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging. Invest Radiol 2003;38:250-6. Observational-Dx 62 patients To evaluate the role of F-18-fluorodeoxyglucose positron-emission tomography (F-18 FDG PET) in the follow-up of breast carcinoma in case of clinical suspicion of local recurrence or distant metastases and/or tumor marker increase in correlation to conventional imaging. On a patient base, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting local recurrence or distant metastases were calculated to be 97%, 82%, 87%, 96% and 90% compared with 84%, 60%, 73%, 75% and 74% with CI. On a lesion base, significantly more lymph node (84 vs. 23, P < 0.05) and fewer bone metastases (61 vs. 97, P < 0.05) could be detected by using F-18 FDG PET compared with CI. Sclerotic bone lesions were predominantly detected by BS. On the other hand, there were several patients with more FDG positive bone lesions and also mixed FDG positive/Tc-99m methylenediphosphonate (MDP) negative and FDG negative/Tc-99m MDP positive metastases. In case of normal tumor markers, sensitivity, specificity, PPV, NPV and accuracy for detecting local recurrence or distant metastases were calculated to be 100%, 85.0%, 78.6%, 100% and 90.3% for FDG PET and 80%, 50%, 50%, 80% and 61.5% for CI. An upstaging could be observed in 9.7% (6/62) and downstaging in 12.9% (8/62), leading to a change in therapeutic regimen in 13 patients (21%). 3
27. Huyge V, Garcia C, Vanderstappen A, Alexiou J, Gil T, Flamen P. Progressive osteoblastic bone metastases in breast cancer negative on FDG-PET. Clin Nucl Med 2009;34:417-20. Review/Other-Dx 1 patient To report a case of a 65-year-old woman with a suspicion of recurrent breast cancer based on an increasing serum tumor marker. No results stated in abstract. 4
28. Ozulker T, Kucukoz Uzun A, Ozulker F, Ozpacac T. Comparison of (18)F-FDG-PET/CT with (99m)Tc-MDP bone scintigraphy for the detection of bone metastases in cancer patients. Nucl Med Commun. 31(6):597-603, 2010 Jun. Observational-Dx 70 patients Retrospective study to assess the efficacy of FDG-PET/CT scan in detecting bone metastases in cancer patients and to compare the results with bone scan findings. FDG-PET/CT imaging detected bone involvement in 68/70 patients with a sensitivity of 97.1%. While bone scan showed the presence of metastases in 60 patients (85.7%). PET/CT detected 666/721 metastatic lesions correctly (92.3%), whereas bone scan detected 506 lesions totally (70.1%). PET/CT revealed organ metastases in 24 patients and in 7 patients with unknown primary; PET/CT also depicted primary tumor. FDG-PET/CT is more sensitive than bone scan in detecting bone metastasis in patients with neoplastic diseases. FDG-PET/CT has the advantage of detecting unknown primary cancers and visceral metastases besides bone metastases. 2
29. Kalus S, Saifuddin A. Whole-body MRI vs bone scintigraphy in the staging of Ewing sarcoma of bone: a 12-year single-institution review. Eur Radiol. 29(10):5700-5708, 2019 Oct. Observational-Dx 182 patients To compare whole-body MRI (WB-MRI) at 1.5/3T and bone scintigraphy in the skeletal staging of Ewing sarcoma (ES) of bone. Skeletal metastases were detected overall in 30 patients (16.5%), in 23 of 96 patients (24%) who underwent WB-MRI, and in 20 of 118 patients (16.9%) who underwent bone scintigraphy. Of 71 patients who underwent both WB-MRI and bone scintigraphy, skeletal metastases were detected on both modalities in 13 (18.3%), while in 4 patients, skeletal metastases were identified on WB-MRI alone. There were no patients in whom skeletal metastases were identified on bone scintigraphy alone. Of 13 patients with skeletal metastases who underwent both studies, WB-MRI showed a greater number of metastatic foci in 10 (76.9%). 4
30. Adusumilli P, Nejadhamzeeigilani H, Pitts K, et al. Protocol-driven multidetector SPECT/CT: integration of hybrid imaging into the routine workflow of whole-body bone scintigraphy in oncology patients. Clin Radiol. 75(1):79.e1-79.e7, 2020 01. Observational-Dx 444 patients To analyse the additional clinical value of protocol-driven and selective use of multidetector single-photon-emission tomography/computed tomography (SPECT/CT) in oncology patients undergoing whole-body bone scintigraphy (BS) and to analyse reporter confidence in diagnosis with and without SPECT/CT. There was a 74.5% increase in definitive diagnostic classification and a 26.6% reduction in equivocal findings with SPECT/CT when compared to BS alone (p<0001). Of cases initially classified as "probably benign" on BS, 5.1% (10/193) were reclassified to "probably malignant" (1%) or "malignant" (4.1%) using the SPECT/CT data. The highest impact in reporter confidence was seen with SPECT/CT in the interpretation of lesions within the pelvis (34%), ribs (23%), lumbar spine (22%), and thoracic spine (21%). 2
31. Webb HR, Latifi HR, Griffeth LK. Utility of whole-body (head-to-toe) PET/CT in the evaluation of melanoma and sarcoma patients. Nuclear Medicine Communications. 39(1):68-73, 2018 Jan. Review/Other-Dx A total of 194 patients were included in the melanoma study and 44 patients were included in the sarcoma study. The aim of this study was to assess the added benefit of whole-body (head-to-toes) PET/CT versus routine 'eyes-to-thighs' PET/CT of melanoma and sarcoma patients. We reviewed reports from 352 PET/CT examinations in 194 patients with melanoma and 75 PET/CT examinations in 44 patients with sarcoma. Melanoma: 13 patients had brain metastases on PET. In five of these patients, lesions were unknown, but all were in the setting of other metastatic disease. Twenty-seven patients had lower extremity metastases, all in the setting of other metastatic disease. No lower extremity metastases were found in the remaining 167 patients. Sarcoma: one patient had an isolated, unexpected brain metastasis. Six patients had leg metastases, but none were isolated. No lower extremity metastases were found in the remaining 38 patients. 4
32. Antoch G, Vogt FM, Freudenberg LS, et al. Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology. JAMA. 2003;290(24):3199-3206. Observational-Dx 98 patients To determine the staging accuracies of both whole-body positron emission tomography (PET) /computed tomography (CT) and whole-body Magnetic resonance imaging (MRI) for different malignant diseases. Of 98 patients, the overall tumor, node and metastasis (TNM) stage was correctly determined in 75 with PET/CT (77%; 95% confidence interval [CI], 67%-85%) and in 53 with MRI (54%; 95% CI, 44%-64%) (P<.001). Compared with MRI, PET/CT had a direct impact on patient management in 12 patients. Results from MRI changed the therapy regimen in 2 patients compared with PET/CT. Separate assessment of T-stage (with pathological verification) in 46 patients revealed PET/CT to be accurate in 37 (80%; 95% CI, 66%-91%) and MRI to be accurate in 24 (52%; 95% CI, 37%-67%) (P<.001). Of 98 patients, N-stage was correctly determined in 91 patients with PET/CT (93%; 95% CI, 86%-97%) and in 77 patients with MRI (79%; 95% CI, 69%-86%) (P =.001). Both imaging procedures showed a similar performance in detecting distant metastases. 2
33. Daldrup-Link HE, Franzius C, Link TM, et al. Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJR Am J Roentgenol. 2001;177(1):229-236. Observational-Dx Thirty-nine children and young adults who were 2--19 years old. To compare the diagnostic accuracy of whole-body MR imaging, skeletal scintigraphy, and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for the detection of bone metastases in children. Twenty-one patients exhibited 51 bone metastases. Sensitivities for the detection of bone metastases were 90% for FDG PET, 82% for whole-body MR imaging, and 71% for skeletal scintigraphy; these data were significantly different (p < 0.05). False-negative lesions were different for the three imaging modalities, mainly depending on lesion location. Most false-positive lesions were diagnosed using FDG PET. 2
34. Schmidt GP, Schoenberg SO, Schmid R, et al. Screening for bone metastases: whole-body MRI using a 32-channel system versus dual-modality PET-CT. Eur Radiol. 17(4):939-49, 2007 Apr. Observational-Dx 30 patients Prospective, blinded study to evaluate the diagnostic accuracy of WB-MRI compared with combined FDG-PET/CT for screening for bone metastases. Sensitivity: WB-MRI 94%, PET/CT 78%. Specificity: WB-MRI 76%, PET/CT 80% Diagnostic accuracy: WB-MRI 91%, PET/CT 78%. WB-MRI revealed 10 additional bone metastases due to the larger field of view. 2
35. Bosma SE, Vriens D, Gelderblom H, van de Sande MAJ, Dijkstra PDS, Bloem JL. 18F-FDG PET-CT versus MRI for detection of skeletal metastasis in Ewing sarcoma. Skeletal Radiol. 48(11):1735-1746, 2019 Nov. Observational-Dx 20 patients with histopathologically confirmed Ewing sarcoma. To determine the level of discrepancy between magnetic resonance imaging (MRI) and 18F-FDG PET-CT in detecting osseous metastases in patients with Ewing sarcoma. A total of 112 osseous lesions were diagnosed in 13 patients, 107 malignant and 5 benign. Seven patients showed no metastases on either 18F-FDG PET-CT or MRI. Forty-one skeletal metastases (39%) detected with MRI did not show increased 18F-FDG uptake on 18F-FDG PET-CT (false-negative). Lesion-based sensitivities and specificities were 62% (95%CI 52-71%) and 100% (48-100%) for 18F-FDG PET-CT; and 99% (97-100%) and 100% (48-100%) for MRI respectively. Bone lesions were more likely to be false-negative on 18F-FDG PET-CT if hematopoietic bone marrow extension was widespread and active (p = 0.001), during or after (neo)-adjuvant treatment (p = 0.001) or when the lesion was smaller than 10 mm (p < 0.001). 2
36. Ricard F, Cimarelli S, Deshayes E, Mognetti T, Thiesse P, Giammarile F. Additional Benefit of F-18 FDG PET/CT in the staging and follow-up of pediatric rhabdomyosarcoma. Clin Nucl Med. 2011;36(8):672-677. Observational-Dx 13 patients To evaluate FDG-PET/CT as an adjunct to conventional imaging in the staging and follow-up of pediatric rhabdomyosarcoma. At staging, FDG-PET/CT revealed 1 rhabdomyosarcoma of the prostate missed by conventional imaging, and found 19 true-positive lymph node territories in 4 patients and 11 bone metastases in 3 patients, vs 12 and 3, respectively, with conventional imaging. Conversely, FDG-PET/CT was less sensitive for detecting infracentimetric lung nodules in 1 patient. On the whole analysis, FDG-PET/CT modified lymph node staging in 4/13 patients, bone involvement in 2 patients, and led to treatment alteration in 2 children. 2
37. Volker T, Denecke T, Steffen I, et al. Positron emission tomography for staging of pediatric sarcoma patients: results of a prospective multicenter trial. J Clin Oncol. 25(34):5435-41, 2007 Dec 01. Observational-Dx 46 pediatric patients Prospective multicenter trial to evaluate the impact of PET using FDG for initial staging and therapy planning in pediatric sarcoma patients. FDG-PET was compared with conventional imaging modalities. For detection of primary tumors, both FDG-PET and conventional imaging modalities had accuracy of 100%.For correct detection of lymph node involvement, PET was superior to conventional imaging modalities (sensitivity, 95% vs 25%, respectively) and bone manifestations (sensitivity, 90% vs 57%, respectively). CT was more reliable than FDG-PET in depicting lung metastases (sensitivity, 100% vs 25%, respectively). 3
38. Eiber M, Takei T, Souvatzoglou M, et al. Performance of whole-body integrated 18F-FDG PET/MR in comparison to PET/CT for evaluation of malignant bone lesions. J Nucl Med. 55(2):191-7, 2014 Feb. Observational-Dx 119 patients To evaluate the diagnostic performance of whole-body integrated (18)F-FDG PET/MR specifically for bone lesions and to analyze differences in standardized uptake value (SUV) quantification between PET/MR and PET/CT. In total, 98 bone lesions were identified in 33 of 119 patients, and 630 regions of normal bone were analyzed. Visual lesion conspicuity on PET was comparable for PET/CT (mean rating, 2.82 ± 0.45) and PET/MR (2.75 ± 0.51; P = 0.3095). Anatomic delineation and allocation of suggestive lesions was significantly superior with T1-weighted TSE MRI (mean rating, 2.84 ± 0.42) compared with CT (2.57 ± 0.54, P = 0.0001) or T1-weighted VIBE Dixon MRI (2.57 ± 0.54, P = 0.0002). No significant difference in correct classification of malignant bone lesions was found among sets A (85/90), B (84/90), and C (86/90). For bone lesions and regions of normal bone, a highly significant correlation existed between the mean SUVs for PET/MR and PET/CT (R = 0.950 and 0.917, respectively, each P < 0.001). However, substantially lower mean SUVs were found for PET/MR than for PET/CT both for bone lesions (12.4% ± 15.5%) and for regions of normal bone (30.1% ± 27.5%). 3
39. Lofgren J, Mortensen J, Rasmussen SH, et al. A Prospective Study Comparing 99mTc-Hydroxyethylene-Diphosphonate Planar Bone Scintigraphy and Whole-Body SPECT/CT with 18F-Fluoride PET/CT and 18F-Fluoride PET/MRI for Diagnosing Bone Metastases. J Nucl Med. 58(11):1778-1785, 2017 11. Observational-Dx 117 patients with histologically proven malignancy. To evaluate and compare the diagnostic performance of 99mTc-hydroxyethylene-diphosphonate (99mTc-HDP) planar bone scintigraphy (pBS), 99mTc-HDP SPECT/CT, 18F-NaF PET/CT, and 18F-NaF PET/MRI for the detection of bone metastases. Bone metastases were confirmed in 16 patients and excluded in 101, which was lower than expected. The number of equivocal scans was significantly higher for pBS than for SPECT/CT and PET/CT (18 vs. 5 and 6, respectively; P = 0.004 and 0.01, respectively). When equivocal readings were excluded, no statistically significant difference in sensitivity, specificity, positive predictive value, negative predictive value, or overall accuracy were found when comparing the different imaging techniques. In the per-patient analysis, equivocal scans were either assumed positive for metastases ("pessimistic analysis") or assumed negative for metastases ("optimistic analysis"). The percentages of misdiagnosed patients for the pessimistic analysis were 21%, 15%, 9%, and 7% for pBS, SPECT/CT, PET/CT, and PET/MRI, respectively. Corresponding figures for the optimistic analysis were 9%, 12%, 5%, and 7%. In those patients identified as having bone metastases according to the reference standard, SPECT/CT, 18F-NaF PET/CT, and PET/MRI detected additional lesions compared with pBS in 31%, 63%, and 71%, respectively. 2
40. Durr HR, Rauh J, Baur-Melnyk A, et al. Myxoid liposarcoma: local relapse and metastatic pattern in 43 patients. BMC Cancer 2018;18:304. Review/Other-Dx 43 patients To analyze the local control rate, the metastatic pattern and survival of patients in a consecutive single-institution series. The lower extremity was involved in 40 cases, the mean tumour size was 12 cm. In 31 cases a wide and in 12 cases a marginal resection was performed. Grading was G1 in 14, G2 in 25 and G3 in 4 cases. Nine patient died in follow-up, 4 of them with metastatic disease, all nonpulmonary. 5-year local recurrence (LR) free survival was 82%. 4 (9.3%) patients developed LR (all R1). Overall survival (OS) was 81% after 5 and 72% after 10 years. In multivariate analysis age and Grading proved to be significant on OS. 4
41. Gorelik N, Reddy SMV, Turcotte RE, et al. Early detection of metastases using whole-body MRI for initial staging and routine follow-up of myxoid liposarcoma. Skeletal Radiol 2018;47:369-79. Observational-Dx 33 patients To define the role of whole-body MRI (WBMRI) for initial staging and routine follow-up of myxoid liposarcoma (MLS). Nine patients (27%) were diagnosed with metastases between 0 and 60 months (median 10; interquartile range, 7-13) from the diagnosis of the primary tumor. The initial site of metastatic disease was extrapulmonary in all patients. Only two patients developed pulmonary metastases, which were diagnosed by CT chest 9 and 29 months after the diagnosis of extrapulmonary metastases. The first metastasis was diagnosed by WBMRI in seven patients (78%), by thoracic CT in one patient, and by abdominal CT in one patient. Eight of nine patients (89%) were asymptomatic at the time of diagnosis of the metastases. In seven patients (78%), WBMRI demonstrated metastases included within the field of view of, but occult on a contemporaneous CT scan. 4
42. Gouin F, Renault A, Bertrand-Vasseur A, et al. Early detection of multiple bone and extra-skeletal metastases by body magnetic resonance imaging (BMRI) after treatment of Myxoid/Round-Cell Liposarcoma (MRCLS). Eur J Surg Oncol. 45(12):2431-2436, 2019 Dec. Review/Other-Dx 45 patients To describe metastatic patterns and outcomes in patients through annual BMRI surveillance after diagnosis of MRCLS of the extremities and trunk. At the last follow-up 10 patients (22.2%) had an extra-pulmonary soft-tissue or/and bone metastasis detected in a median delay of 22.7±16 months [0-49] from the diagnosis of the MRCLS. Nine patients were asymptomatic. Finally, 5-years metastatic free survival was 72±8%. All metastatic patients had multiple lesion within the year following the first lesion diagnosis. 4
43. Noble JL, Moskovic E, Fisher C, Judson I. Imaging of skeletal metastases in myxoid liposarcoma. Sarcoma 2010;2010:262361. Review/Other-Dx 8 patients To examine the prevalence of known bone metastases in our patient population and report our experience of diagnostic imaging with MRCL. Eight patients (4.3%) developed skeletal metastases all of which were positive on MRI. Bone scintigraphy was negative in two out of four cases, CT was negative in six out of seven, and X-rays were negative in four. Radiography and CT measure mainly cortical bone involvement, whereas MRI examines bone marrow. 4
44. Stevenson JD, Watson JJ, Cool P, et al. Whole-body magnetic resonance imaging in myxoid liposarcoma: A useful adjunct for the detection of extra-pulmonary metastatic disease. Eur J Surg Oncol. 42(4):574-80, 2016 Apr. Observational-Dx 28 patients The optimal radiological modality to detect extra-pulmonary metastases for systemic staging has not been proven. We reviewed the efficacy of Whole-Body MRI (WBMRI) for this purpose. 38 metastases were identified in seven patients via WBMRI. Osseous lesions predominated (spine, pelvis, chest-wall and long bones), followed by soft-tissue and abdominal lesions. Of the 29 soft-tissue or osseous metastases that were within the field-of-view of the simultaneous CT scans, five soft-tissue and zero osseous metastases were identified using CT. Metastatic disease was detected in three patients solely using WBMRI, which directly influenced their management. 3
45. Gamboa AC, Ethun CG, Switchenko JM, et al. Lung Surveillance Strategy for High-Grade Soft Tissue Sarcomas: Chest X-Ray or CT Scan?. J Am Coll Surg. 229(5):449-457, 2019 11. Review/Other-Dx 909 patients To evaluate the difference between CXR and CT lung surveillance after curative resection of high-grade soft tissue sarcoma in regards to overall survival and cost to the US-healthcare system. Among 909pts, 83% had truncal/extremity, 17% had retroperitoneal (RP) tumors. Recurrence occurred in 48% of which 54% were LM. LS was performed with CT in 80% and CXR in 20%. Both groups were clinically similar although CT patients had more RP tumors and recurrences. Regardless of modality, 85-90% of LM were detected within the first 2yrs with a similar re-intervention rate. When considering age, tumor size, location, margin status, and receipt of radiation, LM was independently associated with worse OS(HR:4.26; p<0.01) while imaging modality was not(HR:1.01; p=0.97). CXR patients did not have an inferior 5-year OS compared to CT(71vs60%, p<0.01). When analyzing patients in whom no LM was detected, both cohorts had a similar 5-year OS(73vs74%, p=0.42), suggesting CXR was not missing clinically relevant lung nodules. When adhering to a guideline-specified protocol for 2018 projected 4,406 cases, surveillance with CXR for 5yrs results in savings of $5-8M/year to the US healthcare system. 4
46. Miller BJ, Carmody Soni EE, Reith JD, Gibbs CP, Scarborough MT. CT scans for pulmonary surveillance may be overused in lower-grade sarcoma. Iowa Orthop J. 2012;32:28-34. Review/Other-Dx 83 patients To determined risk factors for pulmonary metastasis to aid in the hypothetical implementation of selective CT scans. 8 patients had pulmonary metastasis. A protocol based on selective CT scans for high-risk patients would have identified 7 out of 8 lesions. The incremental cost-effectiveness ratio for routine CT scans was $731,400. 4
47. Rehders A, Hosch SB, Scheunemann P, Stoecklein NH, Knoefel WT, Peiper M. Benefit of surgical treatment of lung metastasis in soft tissue sarcoma. Arch Surg 2007;142:70-5; discission 76. Review/Other-Dx 61 patients To analyze our 12 years of experience in treating these patients (operable lung metastasis), with emphasis on prognostic factors. Primary tumor size was pT1 in 13 patients and pT2 in 48 patients. The differentiation was high in 7 patients, intermediate in 19 patients, and low in 35 patients. The mean number of resected pulmonary metastatic lesions was 5 (range, 1-48). An anterolateral thoracotomy was performed in 39 patients, and sternotomy in 22 patients. There were no significant postoperative complications that required surgical revision. The perioperative mortality was 0%. At a mean follow-up of 60 months, the mean survival time after metastasectomy was 33 months (range, 2-125 months). The 5-year survival was 25%. The number of resected lung metastatic lesions had no prognostic relevance (P = .37). 4
48. Cipriano CA, Jang E, Tyler W. Sarcoma Surveillance: A Review of Current Evidence and Guidelines. [Review]. J Am Acad Orthop Surg. 28(4):145-156, 2020 Feb 15. Review/Other-Dx N/A To understand the existing research and guidelines to determine optimal surveillance strategies. No results stated in abstract. 4
49. Dangoor A, Seddon B, Gerrand C, Grimer R, Whelan J, Judson I. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016;6:20. Review/Other-Dx N/A To provide a brief review of the current state of established knowledge in sarcoma diagnosis and management, with guidance on what is considered current best practice in the UK. No results stated in abstract. 4
50. Gerrand C, Athanasou N, Brennan B, et al. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res 2016;6:7. Review/Other-Dx N/A To provide a reference standard for the clinical care of patients in the UK with bone sarcomas. No results stated in abstract. 4
51. ESMO/European Sarcoma Network Working Group.. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 25 Suppl 3:iii102-12, 2014 Sep. Review/Other-Dx N/A To provide guidance for diagnosis, treatment and follow-up of Soft tissue and visceral sarcomas. No results stated in abstract. 4
52. von Mehren M, Randall RL, Benjamin RS, et al. Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw.. 16(5):536-563, 2018 05. Review/Other-Dx N/A To address the management of soft tissue sarcoma in adults. No results stated in abstract. 4
53. Puri A, Ranganathan P, Gulia A, Crasto S, Hawaldar R, Badwe RA. Does a less intensive surveillance protocol affect the survival of patients after treatment of a sarcoma of the limb? updated results of the randomized TOSS study. Bone Joint J 2018;100-B:262-68. Experimental-Dx 500 patients To show non-inferiority of a chest radiograph (CXR) group compared with a CT scan group, and of a less frequent (six-monthly) group than a more frequent (three-monthly) group, in two-by-two comparison. The updated results recorded 12 (2.4%) local recurrences, 182 (36.8%) metastases, and 56 (11.3%) combined (local + metastases) recurrence at a median follow-up of 81 months (60 to 118). Of 68 local recurrences, 60 (88%) were identified by the patients themselves. The six-monthly regime (overall survival (OS) 54%, recurrence-free survival (RFS) 46%) did not lead to a worse survival and was not inferior to the three-monthly regime (OS 55%, RFS 47%) in terms of detecting recurrence. Although CT scans (OS 53%, RFS 54%) detected pulmonary metastasis earlier, it did not lead to a better survival compared with CXR (OS 56%, RFS 59%). 2
54. Puri A, Gulia A, Hawaldar R, Ranganathan P, Badwe RA. Does intensity of surveillance affect survival after surgery for sarcomas? Results of a randomized noninferiority trial. Clin Orthop. 472(5):1568-75, 2014 May. Experimental-Dx 500 patients To assess if the less intensive follow-up regimens led to worsened survival. Three-year OS and DFS for all patients was 67% and 52%, respectively. Three-year OS was 67% and 66% in chest radiography and CT groups, respectively (HR, 0.9; upper 90% confidence interval [CI], 1.13). DFS rate was 54% and 49% in chest radiography and CT groups, respectively (HR, 0.82; upper 90% CI, 0.97). Three-year OS was 64% and 69% in 6-monthly and 3-monthly groups, respectively (HR, 1.2; upper 90% CI, 1.47). DFS was 51% and 52% in 6-monthly and 3-monthly groups, respectively (HR, 1.01; upper 90% CI, 1.2). Almost 90% of local recurrences were identified by patients themselves. 2
55. Rissing S, Rougraff BT, Davis K. Indeterminate pulmonary nodules in patients with sarcoma affect survival. Clin Orthop Relat Res. 2007; 459:118-121. Observational-Dx 331 patients Prospectively study sarcoma patients to see if small, indeterminate pulmonary nodules are of prognostic significance. 71 (21%) had indeterminate pulmonary nodules on initial spiral CT. 20/71 (28%) progressed with metastatic disease. Metastatic disease developed in 18/20 (90%) in the area of the original indeterminate nodule. The presence of tiny (<5 mm) indeterminate nodules was not a prognostic variable, however, the presence of nodules =5 mm was associated with worse 3 year disease-free survival compared to those with no nodules or tiny nodules (81% vs 49%) but better than those with definite metastatic disease at presentation (49% vs 5%). 3
56. Cho HS, Park IH, Jeong WJ, Han I, Kim HS. Prognostic value of computed tomography for monitoring pulmonary metastases in soft tissue sarcoma patients after surgical management: a retrospective cohort study. Ann Surg Oncol. 2011; 18(12):3392-3398. Observational-Dx 176 patients To evaluate the prognostic value of CT of the chest in soft tissue sarcoma patients after surgery. The overall 5- and 10-year survival rates of 176 patients were 75.6% and 70.3%, respectively. The 5-year survival estimates of 96 patients who were included in the plain radiograph cohort and 80 patients in the chest CT cohort were 74.2% and 76.6%, respectively (P=0.70). 54 patients (30.7%) had pulmonary metastasis. Of the 54 patients, 26 belonged to the plain radiograph cohort and 28 patients belonged to the chest CT cohort. Pulmonary metastasis of chest CT cohort had the tendencies of unilaterality, a smaller number of patients, and management with metastasectomy other than palliative management. The 2- and 4-year survival rates after detection of pulmonary metastasis were 20.1% and 0% in the plain radiograph cohort and 47.4% and 31.6% in the chest CT cohort (P<0.05). 3
57. Whooley BP, Gibbs JF, Mooney MM, McGrath BE, Kraybill WG. Primary extremity sarcoma: what is the appropriate follow-up? Ann Surg Oncol 2000;7:9-14. Observational-Dx 141 patients To evaluate the effectiveness of follow-up tests for detecting first local and distant recurrences in patients with primary extremity soft tissue sarcoma. Of 141 patients who were assessable, 29 patients developed local recurrence and 57 developed distant recurrence. All but one of the local recurrences was detected on the basis of an abnormal physical examination. Of the 29 patients who developed local recurrence, 25 were resected. Distant metastases were detected because of symptoms in 21 cases. Of the 36 asymptomatic lung recurrences, 30 were detected by follow-up chest x-ray. Of the 36 asymptomatic lung recurrences, 24 patients underwent metastasectomy. The positive and negative predictive values of surveillance chest x-ray were 92% and 97%, respectively. Laboratory testing never led to the detection of recurrence. 3
58. Bertrand TE, Cruz A, Binitie O, Cheong D, Letson GD. Do Surgical Margins Affect Local Recurrence and Survival in Extremity, Nonmetastatic, High-grade Osteosarcoma?. Clin Orthop. 474(3):677-83, 2016 Mar. Observational-Tx 241 patients To determine if surgical margins affect recurrence and survival. Local recurrence was noted to be 14% (seven of 51) at 3.4 years. After controlling for relevant confounding variables, the presence of a positive margin compared with a negative margin > 1 mm was the only independent predictor of local recurrence (hazard ratio [HR], 8.006; 95% confidence interval [CI], 1.314–48.781; p = 0.0241). At a mean of 3.4 years, 29% (15 of 51) of the patients developed metastatic disease with no difference with the numbers available in the probability of developing metastatic disease among the three margin groups (p = 0.614). Overall survival at 3.8 years was 75% (38 of 51). After controlling for relevant confounding variables, we found that patients with positive margins were more likely to die from disease than those with negative margins (HR, 6.26; 95% CI, 1.50–26.14; p = 0.0119); no other independent predictors of survival were identified. 2
59. Kasalak O, Dammann A, Adams HJA, et al. Surveillance MRI for the detection of locally recurrent Ewing sarcoma seems futile. Skeletal Radiol. 47(11):1517-1522, 2018 Nov. Review/Other-Dx 32 patients including 176 local surveillance MRI scans To determine the frequency of locally recurrent Ewing sarcoma on surveillance MRI and the outcome of these patients. Follow-up time of surveillance MRI after completion of primary treatment ranged between 1 and 111 months. Surveillance MRI detected five (15.6%) locally recurrent Ewing sarcomas, at 2, 4, 6, 6, and 7 months after completion of primary treatment, of whom three also had simultaneous recurrent (metastatic) disease elsewhere. Two patients had recurrent metastatic disease without any signs of locally recurrent disease on surveillance MRI. All five patients with locally recurrent disease on surveillance MRI died, at 2, 4, 5, 8, and 9 months after local recurrence detection. Patients with locally recurrent disease had a significantly worse overall survival than patients without locally recurrent disease (log-rank test, P < 0.0001). 4
60. Takeuchi A, Lewis VO, Satcher RL, Moon BS, Lin PP. What are the factors that affect survival and relapse after local recurrence of osteosarcoma?. Clin Orthop. 472(10):3188-95, 2014 Oct. Observational-Tx 45 patients To evaluate the long-term oncologic outcome of patients who were treated for local recurrence of osteosarcoma. Overall postrecurrence patient survival was 30% at 5 years and 13% at 10 years. Cox multivariate analysis revealed that concurrent metastasis (relative risk = 4, p = 0.003) and recurrent tumor size 5 cm or larger (relative risk = 13, p < 0.0001) were independent predictors of worse survival. With the numbers available, treatment with chemotherapy after local recurrence was not associated with better survival (p = 0.54). Nine patients had a second local recurrence, and the actuarial risk of rerecurrence was 34% at 5 years. There was no difference in the frequency of rerecurrence between patients treated by amputation and wide local excision (p = 0.23). 2
61. Wasilewski-Masker K, Liu Q, Yasui Y, et al. Late recurrence in pediatric cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 2009;101:1709-20. Review/Other-Dx 12,795 patients To estimate late recurrence rates for the most common pediatric cancers and to determine risk factors for late recurrence. Overall, 5-year survivors of pediatric cancers experienced a cumulative incidence of recurrent disease of 4.4%, 5.6%, and 6.2% at 10, 15, and 20 years, respectively. Cumulative incidence varied by diagnosis: Survivors of Ewing sarcoma and astrocytoma had the highest 20-year cumulative incidences at 13.0% (95% confidence interval [CI] = 9.4 to 16.5) and 14.4% (95% CI = 12.3 to 16.6), respectively. In multivariable analysis, the greatest risk factors for late recurrence included diagnosis, combination treatment with chemotherapy and radiation, earlier treatment era, and fewer years since diagnosis (P < .001 for all). 4
62. Bacci G, Longhi A, Ferrari S, et al. Pattern of relapse in 290 patients with nonmetastatic Ewing's sarcoma family tumors treated at a single institution with adjuvant and neoadjuvant chemotherapy between 1972 and 1999. Eur J Surg Oncol 2006;32:974-9. Review/Other-Tx 290 patients To Evaluate pattern of recurrences of 290 patients with an Ewing's sarcoma family tumor (ESFT), who relapsed after adjuvant or neoadjuvant chemotherapy. There were 378 recurrences, treated by surgery, and/or chemotherapy, radiotherapy, or only palliative treatments. At the last control 18 patients were alive and free of disease 2.5 to 20 years (median 12.1 year) from the last treatment, 4 were alive with uncontrolled disease, 2 died of second line chemotherapy-related toxicity, and 266 died of the tumor 4 months to 20.5 years from the first relapse (median 3.2 years). The 5-year event free survival after the last relapse and overall survival were 5.1 and 7.9%, respectively, and resulted significantly correlated with the time of first relapse, the site of first metastases, the treatment performed after relapse (all patients presently free of disease had been treated by surgery alone or combined with a second line chemotherapy) and for patients treated with neoadjuvant chemotherapy and locally by surgery, with the histologic response to preoperative chemotherapy. 4
63. Greenberg DD, Crawford B. Surveillance Strategies for Sarcoma: Results of a Survey of Members of the Musculoskeletal Tumor Society. Sarcoma 2016;2016:8289509. Review/Other-Dx 38 Musculoskeletal Tumor Society members To determine the current sarcoma surveillance strategies of members of the Musculoskeletal Tumor Society (MSTS) and the rationale behind them. 20 percent (38 of 193) of MSTS members completed the survey. The primary rationale for protocols was training continuation, followed by published guidelines, and finally personal interpretation of the literature. 95% of the respondents believe that additional studies regarding appropriate surveillance protocols are needed. 87% reported patient concerns regarding radiation exposure from surveillance imaging. For soft tissue and bone sarcoma local recurrence, responders identified surgical margin, histologic grade, and tumor size as the most important factors. For metastases, important risk factors identified included histologic grade, tumor size, and histologic type. Protocols demonstrated wide variation. 4
64. Sharma P, Khangembam BC, Suman KC, et al. Diagnostic accuracy of 18F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma. Eur J Nucl Med Mol Imaging. 40(7):1036-43, 2013 Jul. Observational-Dx 53 patients To evaluate the diagnostic accuracy of (18)F-FDG PET/CT for detecting recurrence in patients with primary skeletal Ewing sarcoma. Of the total of 71 (18)F-FDG PET/CT studies, 42 (59.1%) were positive for recurrence and 29 (40.9%) were negative for recurrence. Local recurrence was most common (38 studies) followed by bone metastasis (9 studies), and node and lung metastasis (2 studies each). Of the 71 studies, 38 were true-positive, 27 were true-negative, 4 were false-positive and 2 were false-negative. Overall per study based sensitivity was 95%, specificity was 87%, PPV was 90%, NPV was 93% and accuracy was 91.5%. No significant difference was found in the accuracy of PET/CT between the suspected recurrence group and the routine follow-up group (94% vs. 84%; P = 0.390). Overall mean lesion SUVmax was 7.8 ± 4.1 (range 1.9-17.2). No site-based difference was found in SUVmax. 3
65. Vadi SK, Mittal BR, Gorla AKR, et al. 18F-FDG PET/CT in Diagnostic and Prognostic Evaluation of Patients With Suspected Recurrence of Chondrosarcoma. Clinical Nuclear Medicine. 43(2):87-93, 2018 Feb. Observational-Dx 31 previously treated patients (46 studies) To analyze the diagnostic and prognostic utility of F-FDG PET/CT to predict the disease-specific survival (DSS) with FDG uptake and tumor grade in recurrent chondrosarcoma. Recurrence (local and distant) was shown in 28 (60.8%) of 46 FDG PET/CT studies with sensitivity and specificity of 88.9% and 78.9%, respectively. The median SUVmax at the recurrent primary sites differed significantly (P = 0.008) among 3 tumor grade groups, with higher median SUVmax in higher grades. There was significant difference in median SUVmax among different grade groups except between grade II and grade III. Recurrent primary site SUVmax cutoff at 6.15 derived from the receiver operating characteristic curve yielded significant difference (P < 0.001) in mean DSS time. Significant difference in survival was noted between 3 different tumor grade groups (P = 0.016). 3
66. Chang KJ, Kong CB, Cho WH, et al. Usefulness of increased 18F-FDG uptake for detecting local recurrence in patients with extremity osteosarcoma treated with surgical resection and endoprosthetic replacement. Skeletal Radiol. 44(4):529-37, 2015 Apr. Observational-Dx 109 extremity osteosarcoma patients with 335 PET/CT scans To investigate the changes of increased F-18 fluorodeoxyglucose ((18)F-FDG) uptake around the prosthesis and its ability to differentiate local recurrence from postsurgical change after endoprosthetic replacement in extremity osteosarcoma. Nine patients (8 %) showed a local recurrence. Mean SUV max at 3, 12, 24, and 36 months was 3.1 ± 1.5, 3.8 ± 1.9, 3.6 ± 1.9, and 3.7 ± 1.5 respectively. In ROC curve analysis, the combination of SUV2 >4.6 and ?SUV >75.0 was a more useful parameter for predicting local recurrence than SUV2 or ?SUV alone. The sensitivity, specificity, and accuracy for identifying local recurrence were 89, 76, 77 % for SUV2; 78, 81, 81 % for ?SUV; and 78, 94, 93 % for the combined criterion respectively. 2
67. Diana Afonso P, Kosinski AS, Spritzer CE. Following unenhanced MRI assessment for local recurrence after surgical resection of mesenchymal soft tissue tumors, do additional gadolinium-enhanced images change reader confidence or diagnosis?. Eur J Radiol. 82(5):806-13, 2013 May. Observational-Dx 87 cases To evaluate if gadolinium enhanced MR imaging (GeMRI) improves confidence, changes the final diagnosis, or improves accuracy in the assessment of musculoskeletal (MSK) tumor residual or recurrence following surgical resection. GeMRI definitely improved confidence in 8/7 cases, and slightly improved confidence in 20/29 cases and changed the final diagnosis in 11/8 cases for R1 and R2 respectively. Positive and negative predictive values statistically improved for R2 (positive predictive value 36.4% versus 50%, p=0.02; negative predictive value 75.4% versus 79.1%, p=0.04) but not for R1. Reader concordance for malignancy improved with GeMRI (?=0.44 pre-contrast and ?=0.71 post-contrast). 3
68. Kransdorf MJ, Murphey MD. The use of gadolinium in the MR evaluation of soft tissue tumors. Semin Ultrasound CT MR 1997;18:251-68. Review/Other-Dx N/A To review the use of intravenous contrast in the evaluation of soft-tissue tumors and tumor-like masses and to make recommendations for the use of gadolinium-enhanced imaging. No results stated in abstract. 4
69. Gronchi A, Lo Vullo S, Colombo C, et al. Extremity soft tissue sarcoma in a series of patients treated at a single institution: local control directly impacts survival. Ann Surg. 2010;251(3):506-511. Review/Other-Tx 997 patients To improve understanding of what is adequate in local treatment of extremity STSs, to maximize the ratio between local control, limb preservation and prognosis. 5- and 10-year mortality estimates (95% CI) were 0.29 (0.20–0.38) and 0.38 (0.28–0.49) in R1 cases, and 0.16 (0.13–0.19) and 0.19 (0.16-0.23) in R0 cases (P=0.0003). Size, grade, depth, and histologic subtype were also significant predictor of mortality. Significant determinants for local relapse were surgical margins, radiation therapy, and histologic subtype. In the subset of R1 resections trends towards a better local control for R1 negative cases and histology other than myxofibrosarcoma were identified. Significant determinants for distant metastases were size, grade and histologic subtype of the tumor but not surgical margins. 4
70. Novais EN, Demiralp B, Alderete J, Larson MC, Rose PS, Sim FH. Do surgical margin and local recurrence influence survival in soft tissue sarcomas? Clin Orthop Relat Res. 2010;468(11):3003-3011. Observational-Tx 248 patients To explore the impact of microscopic margin on local recurrence, metastasis, and OS in patients with intermediate- to high-grade STSs of the extremities. The 5-year cumulative incidence of local recurrence was 4.1%. Patients who presented with positive margins or a margin of =2 mm had a worse survival than patients who had margins of >2 mm and wide margins (5-year survival, 47% vs 70% and 72%). In addition to surgical margin, developing metastasis, tumor response of <90% necrosis, high histopathologic grade, high AJCC stage (stage III), increasing age, and male gender were associated with decreased OS. Local recurrence independently predicted decreased OS. 2
71. Sabolch A, Feng M, Griffith K, et al. Risk factors for local recurrence and metastasis in soft tissue sarcomas of the extremity. Am J Clin Oncol. 2012;35(2):151-157. Observational-Tx 188 patients To review treating STSs of the extremity to identify factors associated with local recurrence, metastasis, and OS, to identify patients who may benefit from intensification of therapy. 188 patients were included in the analysis. 25 (13%) and 46 (24%) experienced local and distant recurrence, respectively. Patients with high/intermediate-grade tumors [HR=5.63, 95% CI: 1.27–24.89, P=0.023] or with multifocally positive margins (HR=4.27, 95% CI: 1.20–15.24, P=0.026) were more likely to fail locally. Those with a preceding local recurrence (HR=8.58, 95% CI: 3.87–19.04, P<0.0001), high/intermediate-grade tumors (HR=5.68, 95% CI: 1.28–25.25, P=0.023), or no secondary re-excision (HR=2.5, 95% CI: 1.09–5.74, P=0.031) were more likely to develop metastasis. Patients with local recurrence (HR=3.6, 95% CI: 1.77–7.29, P<0.001), metastasis (HR=16.0, 95% CI: 7.93–32.31, P<0.0001), or without secondary re-excision (HR=3.2, 95% CI: 1.27–8.09, P=0.014) had decreased OS rate. 2
72. Salas S, Stoeckle E, Collin F, et al. Superficial soft tissue sarcomas (S-STS): a study of 367 patients from the French Sarcoma Group (FSG) database. Eur J Cancer. 2009;45(12):2091-2102. Observational-Tx 367 patients To describe the clinical characteristics of a large series of superficial-STS (n=367) from the French Sarcoma Group (GSF-GETO) database and analyze the prognostic factors affecting outcome. The median age was 59 years. 58% of patients were female. Tumor locations were as follows: extremities, 55%; trunk wall, 35.4%; head and neck, 8% and unknown, 1.6%. Median tumor size was 3.0 cm. The most frequent tumor types were unclassified sarcoma (24.3%) and leiomyosarcoma (22.3%). 33% of cases were grade 3. Median follow-up was 6.18 years. The 5-year OS, metastasis-free survival and local recurrence-free survival rates were 80.9%, 80.7% and 74.7%, respectively. Multivariate analysis retained histological type and wide resection for predicting local recurrence-free survival and histological type and grade as prognostic factors of metastasis-free survival. The factors influencing OS were age, histological type, grade and wide resection. STS with early invasion into but not through the underlying fascia had a significantly poorer metastasis-free survival than with strict superficial-STS. 2
73. Sugiura H, Nishida Y, Nakashima H, Yamada Y, Tsukushi S, Yamada K. Surgical procedures and prognostic factors for local recurrence of soft tissue sarcomas. J Orthop Sci. 19(1):141-9, 2014 Jan. Review/Other-Tx 105 patients To investigate clinical outcomes following surgical procedures for locally recurrent soft tissue sarcomas and risk factors for re-recurrence and metastasis. Overall 5- and 10-year survival rates were 83.4 and 67.7%, respectively. Twenty-one patients (20.0%) had additional local recurrences, and 23 (21.9%) had distant metastases. Amputation rate was 10.5% at the time of surgical procedures and 17.1% at final follow-up. Locations deep within muscles in the upper limb or trunk and surgical margins <1 cm wide were risk factors for further local recurrence. Locations deep within muscles, tumor sizes >10 cm, high-grade malignancy, and local recurrence after radical surgery were risk factors for distant metastasis. 4
74. Alamanda VK, Crosby SN, Archer KR, Song Y, Schwartz HS, Holt GE. Predictors and clinical significance of local recurrence in extremity soft tissue sarcoma. Acta Oncol. 2013;52(4):793-802. Observational-Tx 278 patients To evaluate patients treated for STS of the extremities between 2000 and 2006. Patients who had a positive margin were 3.76 times more likely to develop local recurrence when compared to those with negative margins. This corresponds to a 38% risk of local recurrence if the margins were positive after 6 years vs 12% if the margins were negative. In patients who underwent a re-excision, the presence or absence of residual disease upon re-excision did not have any bearing on local recurrence (P=0.27). In comparing patients with and without local recurrence, there was no statistically significant difference in the rate and the proportion encountering distant metastasis and death due to sarcoma (P>0.05). 2
75. Stojadinovic A, Leung DH, Allen P, Lewis JJ, Jaques DP, Brennan MF. Primary adult soft tissue sarcoma: time-dependent influence of prognostic variables. J Clin Oncol 2002;20:4344-52. Observational-Dx 2,123 patients To define prognostic factors for postrelapse survival and their time-dependent influence for adult soft tissue sarcoma (STS). Two thirds of recurrences developed within 2 years of initial resection. Tumor size (P <.001), grade (P <.001), and microscopic resection margin (P <.001) independently predicted DSS for all STS. Size and grade independently predicted early (DFI <or= 3 years) and margin late (DFI > 3 years) DSS. Risk of tumor-related death was the same across all sites 3 years postresection and decreased significantly for extremity/trunk STS when DFI exceeded 3 years (P <.001). Influence of initial high-risk factors for tumor-related mortality in extremity/trunk STS decreased by 40% 3 years postresection, but their influence over DSS for non-extremity/trunk sites remained constant over time. Likelihood of complete resection after recurrence (all sites) increased with DFI (9% and 33% for DFI < 6 and > 36 months, respectively). 3
76. Rothermundt C, Whelan JS, Dileo P, et al. What is the role of routine follow-up for localised limb soft tissue sarcomas? A retrospective analysis of 174 patients. Br J Cancer. 110(10):2420-6, 2014 May 13. Review/Other-Dx 174 patients To describe the presentation of relapse, the modality of detection of recurrence, and patient outcomes, and to assess the effectiveness of current unit follow-up guidelines. Eighty-two patients (47%) experienced relapse of any type. Isolated local recurrence occurred in 26 patients and local relapse with synchronous pulmonary metastases in five patients. Local recurrences were detected clinically in 30 of these 31 patients; magnetic resonance imaging identified only one local recurrence. Twenty-eight patients developed isolated lung metastases; in nine patients these were amenable to resections, seven of whom are currently free of disease after treatment. Lung metastases were detected by chest x-ray (CXR) in 19 patients, computed tomography scanning in 3 patients, and clinically in 11 patients. Twenty-three patients developed non-pulmonary metastases. More than 80% of relapses occurred in the first 2 years of follow-up; however, later recurrences were also observed. 4
77. Park JW, Yoo HJ, Kim HS, et al. MRI surveillance for local recurrence in extremity soft tissue sarcoma. Eur J Surg Oncol. 45(2):268-274, 2019 02. Observational-Dx 477 patients To examine the usefulness of MRI in detecting LR, 2) to identify the characteristics of LR detected by MRI, and 3) to examine whether MRI surveillance is associated with oncologic outcome. The rate of MRI-detected LR, defined as clinically undetectable LR identified on MRI, was 10.5% in the MRI surveillance cohort. The detection rates of MRI-detected LR were significantly higher in the patients with high risk of LR. MRI-detected LRs were more commonly located in the thigh or buttock (p = 0.005), were smaller (p = 0.001) and had LRs without mass formation (p = 0.007) than non-MRI-detected LRs. On Kaplan-Meier analysis, patients with MRI-detected LR tended to have better post-LR survival (p = 0.104). 3
78. Sawamura C, Matsumoto S, Shimoji T, Okawa A, Ae K. How long should we follow patients with soft tissue sarcomas? Clin Orthop Relat Res 2014;472:842-8. Review/Other-Dx 867 patients To determine the (1) timing of diagnosis of local recurrences after sarcoma excision; (2) timing of diagnosis of distant metastases; and (3) the difference in those parameters based on tumor size and grade. Ninety-eight patients (11%) developed local recurrence at a median time of 19 months; 90% of patients who had local recurrences had them within 7.1 years, and 95% occurred by 8.6 years. One hundred ninety-eight patients (23%) developed distant metastases at a median time of 12 months; 90% of patients who developed metastases developed them by 4.2 years and 95% did so by 7.3 years. High-grade tumors had a higher incidence of local recurrence and metastases in first 2 years, whereas low-grade tumors recurred at a constant rate throughout the followup period. 4
79. Al-Ibraheem A, Buck AK, Benz MR, et al. (18) F-fluorodeoxyglucose positron emission tomography/computed tomography for the detection of recurrent bone and soft tissue sarcoma. Cancer. 119(6):1227-34, 2013 Mar 15. Observational-Dx 43 patients To present a clinical study on the diagnostic accuracy and incremental value of integrated FDG-PET/CT in patients with a history of sarcoma who have clinically suspected disease recurrence. FDG-PET/CT had greater sensitivity and specificity compared with contrast-enhanced CT alone (94% and 92% vs 78% and 67%, respectively), resulting in significantly greater accuracy (93% vs 73%; P=.03). FDG-PET/CT was particularly superior regarding detection of local recurrence or soft tissue lesions (sensitivity and specificity: 83% and 100% vs 50% and 100%, respectively) or bone metastases (100% and 100% vs 85% and 88%, respectively). 2
80. Park SY, Chung HW, Chae SY, Lee JS. Comparison of MRI and PET-CT in detecting the loco-regional recurrence of soft tissue sarcomas during surveillance. Skeletal Radiol. 45(10):1375-84, 2016 Oct. Observational-Dx 152 patients To investigate the diagnostic performance of MRI and PET-CT for the detection of loco-regional recurrences after soft tissue sarcoma (STS) excision. Twenty patients were found to have a loco-regional recurrence after tumor excision. For MRI and PET-CT, the sensitivities were 90.0 and 95.0 %, and the specificities 97.7 and 95.5 %, respectively, with positive predictive values of 85.7 and 76.0 % and negative predictive values of 98.5 and 99.2 %, respectively. No significant difference was detected between the sensitivities of MRI and PET-CT (p = 0.125). The area under the receiver-operating characteristic curve for PET-CT (0.952) was not significantly greater than that for MRI (0.939; p = 0.6). 2
81. Erfanian Y, Grueneisen J, Kirchner J, et al. Integrated 18F-FDG PET/MRI compared to MRI alone for identification of local recurrences of soft tissue sarcomas: a comparison trial. Eur J Nucl Med Mol Imaging. 44(11):1823-1831, 2017 Oct. Observational-Dx 41 patients To assess and compare the diagnostic accuracy of PET/MRI and MRI alone for the detection of local recurrences of soft tissue sarcomas (STS) after initial surgical resection of the primary tumors. Calculated sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the detection of local tumor recurrence was 82%, 86%, 92%, 71% and 83% for MRI, and 96%, 79%, 90%, 92% and 90% for PET/MRI (p > 0.05). Furthermore, PET/MRI showed significantly higher confidence levels (p < 0.05) for the determination of malignant lesions. 2
82. Richardson K, Potter M, Damron TA. Image intensive soft tissue sarcoma surveillance uncovers pathology earlier than patient complaints but with frequent initially indeterminate lesions. J Surg Oncol. 113(7):818-22, 2016 Jun. Observational-Dx 39 patients To evaluate an image intense protocol to assess benefits of identifying true pathology compared to incidental findings. 24/39 (61.5%) patients were identified to have a local recurrence (6), chest metastasis (6), isolated distant recurrence (9), or new primary tumor (3). Of those 24 patients with true pathology, 13 (54%) or 33% (13/39) of all patients potentially benefited from discovery via imaging before patient complaint. Chest CT was the first to reveal all lung metastases. For balance, 32/39 (82%) patients had at least 1 initially "indeterminate" lesion on imaging. Of those, 91% (29/32)-74% of all patients (29/39)-proved to be inconsequential by final follow up. 3
83. Labarre D, Aziza R, Filleron T, et al. Detection of local recurrences of limb soft tissue sarcomas: is magnetic resonance imaging (MRI) relevant?. Eur J Radiol. 72(1):50-3, 2009 Oct. Observational-Dx 124 patients To retrospectively evaluate the effectiveness of a systematic MRI examination performed in patients treated for a non-metastatic limb soft tissue sarcomas. 86 patients (70%) had clear resection margins (R0) and 111 patients (90%) received an adjuvant radiotherapy. Among the 11 local recurrences (9%) which were observed, MRI was able to detect only 2 asymptomatic local recurrences, one with and one without synchronous metastasis. Both had microscopically involved margins (R1). In contrast, MRI showed 11 false positive cases. As the predictive positive value of MRI was 42%, clinical follow-up seems to be more effective. 3
84. Tagliafico A, Truini M, Spina B, et al. Follow-up of recurrences of limb soft tissue sarcomas in patients with localized disease: performance of ultrasound. Eur Radiol. 25(9):2764-70, 2015 Sep. Observational-Dx 68 patients To evaluate diagnostic performance of ultrasound in the detection of local recurrences in patients with localized soft tissue sarcomas of the limb. The overall sensitivity and specificity were 0.88 (0.60-0.94) and 0.94 (0.86-0.98). PPV, pre-test probability, NPV, LH+, accuracy and post-P: 0.83/0.25/0.96/14.9/0.92/0.83. There were two false negative cases both graded as G3 and deeply located and three false positive US cases. Diagnostic accuracy was not dependent by US machine (p = 0.08), age and sex (p = 0.16), body mass index (p = 0.07) and radiologists (p = 0.07). 3
85. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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