Materiały źródłowe

• #1 Soft tissue sarcoma: Recognizing a rare disease | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/2/73

  The recognition of a malignant soft tissue mass can be challenging, given the rarity of soft tissue sarcoma and the extensive overlap between benign and malignant presentations. […] Awareness of the signs and symptoms of soft tissue sarcoma in primary care practice ensures prompt referral to a sarcoma center for appropriate assessment and treatment to optimize outcomes. […] The rarity of soft tissue sarcoma, its heterogeneity, and overlap of symptoms with benign conditions are challenges to timely diagnosis. […] Patients suspected of having a soft tissue sarcoma require prompt referral to a sarcoma center for assessment and treatment. […] Early recognition of the signs and symptoms of soft tissue sarcoma (STS) and prompt referral to a center with expertise in STS are essential to ensure effective multidisciplinary team management and optimize outcome.

• #2 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5702952/

  The relatively low incidence and often atypical clinical presentation of soft-tissue sarcomas (STS) impedes early and adequate diagnosis. […] A thorough diagnostic work-up is essential in order to distinguish between benign soft-tissue tumours and STSs. Patient history, clinical features and radiological findings all help in assessing the underlying pathology. Worrying features such as recent increase in size, deep location relative to the fascia, a tumour exceeding 4 cm in size, and invasive growth patterns seen on imaging should prompt verification by biopsy. […] The diagnostic pathway should always start with a thorough documentation of the patients history. Lumps that have not changed in size or shape over the years are most likely benign, whereas recently noticed, constantly-enlarging swellings should urge caution.

• #3 Soft tissue sarcoma: clinical recognition and approach to the loneliest cancer

  https://www.explorationpub.com/Journals/emd/Article/100734

  Soft tissue sarcoma (STS) is a rare malignancy with a high incidence. Early diagnosis can reduce the rate of amputations and increase survival, however, this is typically delayed. […] A timely and precise diagnosis is essential because half of people with STS progress toward quietly aggressive illness. […] The purpose of this review is to raise awareness of STSs so that early recognition, accurate work-up, overview of conventional treatment plans, and appropriate referral to a tumor center can be achieved, avoiding whoop situations, and improving patient outcomes. […] The clinical symptoms observed in patients with STS are nonspecific, with the most common finding being a painless, gradually enlarging mass with site-dependent symptoms of increased pressure, such as paraesthesia and distal edema.

• #4 Soft Tissue Masses: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0600/p602.html

  When a worrisome mass is found, initial radiography followed by an expedited MRI with contrast are recommended pending radiology recommendation and referral to an orthopedic oncologist. […] If there is a concern for malignancy, biopsy should be performed by the orthopedic oncologist who would manage the potential diagnosis and possible seeding of the biopsy site. […] Soft tissue sarcomas are a broad and heterogenous group of tumors that are most common in adults older than 55 years, although they can occur at any age. […] Most soft tissue sarcomas begin as a gradually enlarging painless mass without constitutional symptoms such as fever or weight loss. […] A soft tissue sarcoma should be considered if an apparent hematoma lasts more than one month. […] Although survival has markedly improved, the overall five-year survival rate is only about 60%.

• #5 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5702952/

  Pain assessment is important in every physician-patient consultation. In cases of STS, however, pain is a rather poor discriminator between benign and malignant lesions. […] As a readily accessible and inexpensive imaging technique, ultrasound (US) is ideal for the initial evaluation of a soft-tissue mass. […] Magnetic resonance imaging (MRI) is the method of choice to evaluate soft-tissue tumours and to distinguish benign from malignant lesions, especially if prior clinical findings and imaging were inconclusive. […] This is an essential part of the diagnostic pathway for soft-tissue tumours. […] The histological classification of STSs is an integral part of the diagnostic pathway. […] The diagnosis of STS can be challenging. A thorough diagnostic workup is usually required to distinguish malignant from benign soft-tissue lesions. If performed only partially or inaccurately, misinterpretation of the underlying pathology at best delays ultimate diagnosis. Consequently, unplanned excisions may be performed, necessitating extensive re-resection and adjuvant therapy at tumour centres. […] In order to avoid misdiagnoses, one should follow a standardised diagnostic approach, beginning with the patient history, clinical examination and appropriate imaging prior to conducting biopsy.

• #6 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5702952/

  The relatively low incidence and often atypical clinical presentation of soft-tissue sarcomas (STS) impedes early and adequate diagnosis. […] A thorough diagnostic work-up is essential in order to distinguish between benign soft-tissue tumours and STSs. Patient history, clinical features and radiological findings all help in assessing the underlying pathology. Worrying features such as recent increase in size, deep location relative to the fascia, a tumour exceeding 4 cm in size, and invasive growth patterns seen on imaging should prompt verification by biopsy. […] The diagnostic pathway should always start with a thorough documentation of the patients history. Lumps that have not changed in size or shape over the years are most likely benign, whereas recently noticed, constantly-enlarging swellings should urge caution.

• #7 Soft Tissue Masses: Evaluation and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0600/p602.html

  Based on strong evidence, lesions that are 5 cm in diameter or larger should be evaluated with advanced imaging or the patient referred because of a higher risk of malignancy. […] Because of the high mortality rate of soft tissue sarcomas and the potential to miss a small sarcoma, any mass that is not definitively diagnosed should be closely monitored or the patient referred to orthopedic oncology. […] When a worrisome mass is found, initial radiography followed by an expedited MRI with contrast are recommended pending radiology recommendation and referral to an orthopedic oncologist. […] Signs that suggest malignancy include tumor size of 5 cm (about the size of a golf ball) or larger, location on or below the fascia, matted to surrounding structures, rapid growth, or recurrence of a mass after prior excision.

• #8 Diagnosis of soft tissue sarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/soft-tissue-sarcoma/diagnosis

  Diagnosis is the process of finding out the cause of a health problem. Diagnosing soft tissue sarcoma can begin with a visit to a doctor, often a specialist. Your doctor will ask you about any symptoms you have and may do a physical exam. The doctor may order tests to check for soft tissue sarcoma or other health problems. But sometimes soft tissue sarcomas are found by chance (incidentally) while checking for a different health problem. […] The following tests are usually used to rule out or diagnose soft tissue sarcoma. Many of the same tests used to diagnose cancer are used to find out how far the cancer has spread (the extent of the cancer). Your doctor may also order other tests to check your general health and to help plan your treatment. […] A physical exam allows your doctor to look for any signs of soft tissue sarcoma. During a physical exam, your doctor may: examine any lumps on your body, including checking their size and shape and how they feel; check how certain parts of your body are moving, such as your arms and legs, and if there is any weakness; examine the lungs; feel the abdomen for an enlarged liver or abnormalities.

• #9 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk in: EFORT Open Reviews Volume 2 Issue 10 (2017)

  https://eor.bioscientifica.com/view/journals/eor/2/10/2058-5241.2.170005.xml

  Due to the complexity of treatment, any soft-tissue swelling suspected of malignancy is best referred directly to a sarcoma centre, where therapeutic management is carefully planned by an experienced multidisciplinary team. […] The diagnostic pathway should always start with a thorough documentation of the patients history. Lumps that have not changed in size or shape over the years are most likely benign, whereas recently noticed, constantly-enlarging swellings should urge caution. […] In cases of STS, however, pain is a rather poor discriminator between benign and malignant lesions. […] As the majority of STSs are located deep to the fascia, every deeply-situated tumour should be considered malignant until proven otherwise. […] The chief objectives of imaging are to confirm clinical findings by detecting a soft-tissue mass, to estimate its size, tissue quality and relation to adjacent structures in detail, and to aid planning of the further course of action.

• #10 Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4706580/

  Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. […] MRI is the modality of choice in the diagnosis and local staging of soft tissue sarcomas. MRI should be performed with intravenous contrast administration, and it is mandatory to obtain images in at least two planes. […] In a patient presenting a soft tissue mass suggestive of sarcoma, the MRI report should provide the following information of the tumour: Size, Location (superficial or deep; compartment or extracompartmental), Anatomical limits, Relationship with neurovascular structures, Extension of perilesional oedema, Pattern of contrast enhancement, Suggestions of areas for biopsy.

• #11 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5702952/

  Pain assessment is important in every physician-patient consultation. In cases of STS, however, pain is a rather poor discriminator between benign and malignant lesions. […] As a readily accessible and inexpensive imaging technique, ultrasound (US) is ideal for the initial evaluation of a soft-tissue mass. […] Magnetic resonance imaging (MRI) is the method of choice to evaluate soft-tissue tumours and to distinguish benign from malignant lesions, especially if prior clinical findings and imaging were inconclusive. […] This is an essential part of the diagnostic pathway for soft-tissue tumours. […] The histological classification of STSs is an integral part of the diagnostic pathway. […] The diagnosis of STS can be challenging. A thorough diagnostic workup is usually required to distinguish malignant from benign soft-tissue lesions. If performed only partially or inaccurately, misinterpretation of the underlying pathology at best delays ultimate diagnosis. Consequently, unplanned excisions may be performed, necessitating extensive re-resection and adjuvant therapy at tumour centres. […] In order to avoid misdiagnoses, one should follow a standardised diagnostic approach, beginning with the patient history, clinical examination and appropriate imaging prior to conducting biopsy.

• #12 Soft tissue sarcoma ultrasound: What to expect

  https://www.medicalnewstoday.com/articles/soft-tissue-sarcoma-ultrasound

  A doctor may use an ultrasound scan as one of the first tests to diagnose and assess a soft tissue sarcoma. An ultrasound can help doctors determine the nature of the lump and plan the most effective treatment. […] One of the first assessments for doctors is ultrasound scanning, followed by other imaging and further testing, such as a biopsy. […] An ultrasound can detect soft tissue lesions, or tumors, with 80-90% accuracy. […] Ultrasounds are particularly useful in providing images of soft tissue sarcomas that would not be visible using X-ray. They can help doctors distinguish between fluid-filled cysts and solid masses that are more likely to be tumors. […] After an ultrasound, doctors will typically order further tests, such as MRI and CT scans, blood testing, or a biopsy. However, ultrasound images cannot always help doctors distinguish between benign and malignant characteristics in the lesions.

• #13 Soft tissue sarcoma ultrasound: What to expect

  https://www.medicalnewstoday.com/articles/soft-tissue-sarcoma-ultrasound

  A doctor may use an ultrasound scan as one of the first tests to diagnose and assess a soft tissue sarcoma. An ultrasound can help doctors determine the nature of the lump and plan the most effective treatment. […] One of the first assessments for doctors is ultrasound scanning, followed by other imaging and further testing, such as a biopsy. […] An ultrasound can detect soft tissue lesions, or tumors, with 80-90% accuracy. […] Ultrasounds are particularly useful in providing images of soft tissue sarcomas that would not be visible using X-ray. They can help doctors distinguish between fluid-filled cysts and solid masses that are more likely to be tumors. […] After an ultrasound, doctors will typically order further tests, such as MRI and CT scans, blood testing, or a biopsy. However, ultrasound images cannot always help doctors distinguish between benign and malignant characteristics in the lesions.

• #14 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk in: EFORT Open Reviews Volume 2 Issue 10 (2017)

  https://eor.bioscientifica.com/view/journals/eor/2/10/2058-5241.2.170005.xml

  Magnetic resonance imaging (MRI) is the method of choice to evaluate soft-tissue tumours and to distinguish benign from malignant lesions, especially if prior clinical findings and imaging were inconclusive. […] This is an essential part of the diagnostic pathway for soft-tissue tumours. […] The histological classification of STSs is an integral part of the diagnostic pathway. Personalised and targeted treatment approaches warrant precise sub-classification into one of more than 117 different soft-tissue tumours defined in the recent WHO Classification of Bone and Soft Tissue Tumours. […] The most common type is high-grade pleomorphic sarcoma, followed by liposarcoma which itself comprises several sub-types leiomyosarcoma, synovial sarcoma and MPNST. […] The diagnosis of STS can be challenging. A thorough diagnostic workup is usually required to distinguish malignant from benign soft-tissue lesions. If performed only partially or inaccurately, misinterpretation of the underlying pathology at best delays ultimate diagnosis. […] Consequently, unplanned excisions may be performed, necessitating extensive re-resection and adjuvant therapy at tumour centres.

• #15 Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4706580/

  Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. […] MRI is the modality of choice in the diagnosis and local staging of soft tissue sarcomas. MRI should be performed with intravenous contrast administration, and it is mandatory to obtain images in at least two planes. […] In a patient presenting a soft tissue mass suggestive of sarcoma, the MRI report should provide the following information of the tumour: Size, Location (superficial or deep; compartment or extracompartmental), Anatomical limits, Relationship with neurovascular structures, Extension of perilesional oedema, Pattern of contrast enhancement, Suggestions of areas for biopsy.

• #16 Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4706580/

  Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. […] MRI is the modality of choice in the diagnosis and local staging of soft tissue sarcomas. MRI should be performed with intravenous contrast administration, and it is mandatory to obtain images in at least two planes. […] In a patient presenting a soft tissue mass suggestive of sarcoma, the MRI report should provide the following information of the tumour: Size, Location (superficial or deep; compartment or extracompartmental), Anatomical limits, Relationship with neurovascular structures, Extension of perilesional oedema, Pattern of contrast enhancement, Suggestions of areas for biopsy.

• #17 Diagnosis of soft tissue sarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/soft-tissue-sarcoma/diagnosis

  A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check your general health, often before a biopsy. […] Blood clotting (coagulation) tests check if your blood is clotting properly. Prothrombin time (PT), partial thromboplastin time (PTT) and international normalized ratio (INR) are common blood clotting tests. They are usually checked before a biopsy is done. […] An MRI is commonly used to examine a lump that doctors think may be a soft tissue sarcoma. It is often the first imaging test done for lumps in the arms or legs. An MRI can check the size of a tumour, what tissues and areas are nearby and if it has spread to other parts of the body. […] A CT scan is commonly used to examine a lump in a specific area, including checking its size and finding out what tissues and areas are nearby. It is often used to check the abdomen, back of the abdomen (retroperitoneum) and chest. If soft tissue sarcoma is diagnosed, a CT scan can be used to check if the cancer has spread to other parts of the body.

• #18 Soft Tissue Sarcoma Diagnosis and Detection

  https://www.cancercenter.com/cancer-types/soft-tissue-sarcoma/diagnosis-and-detection

  PET scans are very sensitive but don’t show much detail, they often are performed in combination with a CT scan (called PET/CT). […] Ultrasound scans may be used to provide information about a tumor or surrounding tissues and organs, and to precisely locate the position of a tumor in order to guide a needle biopsy. […] The lungs are a common location for soft tissue sarcomas to metastasize (spread). Therefore, X-rays of the chest may be taken to see if the cancer has spread to the lungs. […] Laparoscopic ultrasound and laparoscopic biopsies may also be performed by the surgeon to diagnose and stage soft tissue sarcoma. For tumors located within the abdomen, a laparoscopic procedure is sometimes used to diagnose or stage the extent of disease.

• #19 TA – FDG-PET for the diagnosis and management of soft tissue sarcoma

  https://www.cms.gov/medicare-coverage-database/view/technology-assessments.aspx?taid=8

  FDG-PET for the diagnosis and management of soft tissue sarcoma John P.A. Ioannidis, MD Joseph Lau, MD […] Purpose: To perform an assessment on the use of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) in the diagnosis, grading, and management of soft tissue sarcoma (STS). […] Results: Twenty studies were included in this systematic review. By qualitative interpretation, the sensitivity of FDG-PET ranged from 91 to 100% and the specificity varied between 26 to 88% in diagnosing primary lesions. When an SUV cut-off of 2.0 was used to evaluate primary lesions, the sensitivity ranged between 64 to 100% and the specificity ranged between 71 to 100%. Diagnostic performance was similar for primary and recurrent lesions. Limited data on comparisons with MRI and CT scan showed no differences between FDG-PET and these imaging modalities in diagnosing recurrent and metastatic disease.

• #20 Soft Tissue Sarcoma Diagnosis and Detection

  https://www.cancercenter.com/cancer-types/soft-tissue-sarcoma/diagnosis-and-detection

  PET scans are very sensitive but don’t show much detail, they often are performed in combination with a CT scan (called PET/CT). […] Ultrasound scans may be used to provide information about a tumor or surrounding tissues and organs, and to precisely locate the position of a tumor in order to guide a needle biopsy. […] The lungs are a common location for soft tissue sarcomas to metastasize (spread). Therefore, X-rays of the chest may be taken to see if the cancer has spread to the lungs. […] Laparoscopic ultrasound and laparoscopic biopsies may also be performed by the surgeon to diagnose and stage soft tissue sarcoma. For tumors located within the abdomen, a laparoscopic procedure is sometimes used to diagnose or stage the extent of disease.

• #21 Diagnosis of soft tissue sarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/soft-tissue-sarcoma/diagnosis

  During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will show whether or not cancer cells are found in the sample. If cancer is diagnosed, the report will also show the type of cancer and grade of the tumour. […] A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to check if the soft tissue sarcoma has spread to the bone.

• #22 Soft Tissue Sarcoma Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/soft-tissue-sarcoma/soft-tissue-sarcoma-diagnosis.html

  MD Andersons team of specialized surgeons and pathologists is one of the most experienced and skilled in the nation in diagnosing sarcomas. […] We have the latest methods and technology to be sure you get the most accurate diagnosis possible. This can make a difference in the success of your treatment. […] The only way to be certain a tumor is soft tissue sarcoma is a biopsy (removing a small number of cells to examine under a microscope). Imaging tests may be used before or after biopsy to determine the location and extent of the tumor. […] Since sarcomas are complex and can develop in so many places in the body, they can be difficult to diagnose. However, its important to have an accurate diagnosis of the type and extent of the sarcoma before you are treated. […] Getting the wrong diagnosis may actually be harmful and make therapy have less chance for success. A biopsy that is not done correctly can cause the cancer to spread and make your treatment more difficult.

• #23 Soft Tissue Sarcoma Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/soft-tissue-sarcoma/soft-tissue-sarcoma-diagnosis.html

  MD Andersons team of specialized surgeons and pathologists is one of the most experienced and skilled in the nation in diagnosing sarcomas. […] We have the latest methods and technology to be sure you get the most accurate diagnosis possible. This can make a difference in the success of your treatment. […] The only way to be certain a tumor is soft tissue sarcoma is a biopsy (removing a small number of cells to examine under a microscope). Imaging tests may be used before or after biopsy to determine the location and extent of the tumor. […] Since sarcomas are complex and can develop in so many places in the body, they can be difficult to diagnose. However, its important to have an accurate diagnosis of the type and extent of the sarcoma before you are treated. […] Getting the wrong diagnosis may actually be harmful and make therapy have less chance for success. A biopsy that is not done correctly can cause the cancer to spread and make your treatment more difficult.

• #24 Soft Tissue Sarcoma: Diagnosis

  https://healthlibrary.inova.org/Conditions/Cancer/34,17566-1

  If your healthcare provider thinks you might have a soft tissue sarcoma, youll need certain exams and tests to be sure. Diagnosing sarcoma starts with your healthcare provider asking you questions. You’ll be asked about your health history, symptoms, risk factors, and your family’s medical history. Your healthcare provider will also do a physical exam. […] You may have one or more of these tests: […] If you have a lump (tumor) or other symptoms that might be caused by a soft tissue sarcoma, your healthcare provider may do imaging tests. […] If imaging tests suggest you might have a soft tissue sarcoma, tiny pieces of the tumor (called samples) will be taken and examined in a lab. This is called a biopsy. Biopsies for suspected sarcomas must be done by healthcare providers with experience treating these tumors. If not done correctly, a biopsy can lead to the tumor spreading, as well as problems after taking it out later. The type of biopsy done depends on where the tumor is and how big it is.

• #25 Benign and Malignant Soft-Tissue Tumors Workup: Laboratory Studies, Imaging Studies, Tissue Diagnosis

  https://emedicine.medscape.com/article/1253816-workup

  Several biopsy techniques are available, including the following: Fine-needle aspiration biopsy (FNAB), Core needle biopsy, Incisional biopsy, Excisional biopsy. […] The choice of biopsy technique is based on the size and location of the mass and the experience of the surgeon. […] Histologic grading is an important prognostic factor in sarcomas. Therefore, the usual tumor-node-metastases (TNM) scheme is modified into a grade-tumor-node-metastases (GTNM) scheme for classifying soft-tissue tumors. […] The GTNM system, which is clinically very useful, stratifies patients into groups with distinct prognostic patterns.

• #26 Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4706580/

  Percutaneous core needle biopsy (CNB), also known as tru-cut biopsy, is currently recommended for STS diagnosis, because it is minimally invasive and will not limit subsequent surgical interventions. Its accuracy is similar to that of the incisional biopsy, with the added benefit that it does not require hospitalization. […] The pathology report of a tru-cut biopsy should include histological type, histological grade and the results of any additional tests that have been made (immunohistochemistry and/or molecular biology). […] The mainstay of treatment in localized STS is surgery. Wide excision of the tumour is the base of surgical treatment of STS, which implies en bloc resection of all the neoplasm, the neocapsule (or reactive peritumoural tissue) and a variable layer of surrounding healthy tissue, called surgical margin.

• #27 Benign and Malignant Soft-Tissue Tumors Workup: Laboratory Studies, Imaging Studies, Tissue Diagnosis

  https://emedicine.medscape.com/article/1253816-workup

  Several biopsy techniques are available, including the following: Fine-needle aspiration biopsy (FNAB), Core needle biopsy, Incisional biopsy, Excisional biopsy. […] The choice of biopsy technique is based on the size and location of the mass and the experience of the surgeon. […] Histologic grading is an important prognostic factor in sarcomas. Therefore, the usual tumor-node-metastases (TNM) scheme is modified into a grade-tumor-node-metastases (GTNM) scheme for classifying soft-tissue tumors. […] The GTNM system, which is clinically very useful, stratifies patients into groups with distinct prognostic patterns.

• #28 Benign and Malignant Soft-Tissue Tumors Workup: Laboratory Studies, Imaging Studies, Tissue Diagnosis

  https://emedicine.medscape.com/article/1253816-workup

  Several biopsy techniques are available, including the following: Fine-needle aspiration biopsy (FNAB), Core needle biopsy, Incisional biopsy, Excisional biopsy. […] The choice of biopsy technique is based on the size and location of the mass and the experience of the surgeon. […] Histologic grading is an important prognostic factor in sarcomas. Therefore, the usual tumor-node-metastases (TNM) scheme is modified into a grade-tumor-node-metastases (GTNM) scheme for classifying soft-tissue tumors. […] The GTNM system, which is clinically very useful, stratifies patients into groups with distinct prognostic patterns.

• #29 Benign and Malignant Soft-Tissue Tumors Workup: Laboratory Studies, Imaging Studies, Tissue Diagnosis

  https://emedicine.medscape.com/article/1253816-workup

  Several biopsy techniques are available, including the following: Fine-needle aspiration biopsy (FNAB), Core needle biopsy, Incisional biopsy, Excisional biopsy. […] The choice of biopsy technique is based on the size and location of the mass and the experience of the surgeon. […] Histologic grading is an important prognostic factor in sarcomas. Therefore, the usual tumor-node-metastases (TNM) scheme is modified into a grade-tumor-node-metastases (GTNM) scheme for classifying soft-tissue tumors. […] The GTNM system, which is clinically very useful, stratifies patients into groups with distinct prognostic patterns.

• #30 Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4706580/

  Percutaneous core needle biopsy (CNB), also known as tru-cut biopsy, is currently recommended for STS diagnosis, because it is minimally invasive and will not limit subsequent surgical interventions. Its accuracy is similar to that of the incisional biopsy, with the added benefit that it does not require hospitalization. […] The pathology report of a tru-cut biopsy should include histological type, histological grade and the results of any additional tests that have been made (immunohistochemistry and/or molecular biology). […] The mainstay of treatment in localized STS is surgery. Wide excision of the tumour is the base of surgical treatment of STS, which implies en bloc resection of all the neoplasm, the neocapsule (or reactive peritumoural tissue) and a variable layer of surrounding healthy tissue, called surgical margin.

• #31 Benign and Malignant Soft-Tissue Tumors Workup: Laboratory Studies, Imaging Studies, Tissue Diagnosis

  https://emedicine.medscape.com/article/1253816-workup

  Other than histologic and cytogenetic analysis, no specific laboratory tests exist for diagnosing soft-tissue tumors. However, ancillary studies may be indicated as part of the general workup in patients with other systemic conditions. […] The National Comprehensive Cancer Network (NCCN) has issued guidelines on genetic testing for soft-tissue sarcoma. […] Over the past two decades, imaging studies (eg, plain radiography, computed tomography [CT], magnetic resonance imaging [MRI], bone scintigraphy, and positron emission tomography [PET]) have contributed greatly to the management of soft-tissue tumors. Although these studies cannot themselves yield a specific diagnosis (except for a few conditions, such as lipoma or liposarcoma), they are extremely useful for defining anatomic location, tumor extent, and involvement of vital structures.

• #32 Diagnosis of soft tissue sarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/soft-tissue-sarcoma/diagnosis

  A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check your general health, often before a biopsy. […] Blood clotting (coagulation) tests check if your blood is clotting properly. Prothrombin time (PT), partial thromboplastin time (PTT) and international normalized ratio (INR) are common blood clotting tests. They are usually checked before a biopsy is done. […] An MRI is commonly used to examine a lump that doctors think may be a soft tissue sarcoma. It is often the first imaging test done for lumps in the arms or legs. An MRI can check the size of a tumour, what tissues and areas are nearby and if it has spread to other parts of the body. […] A CT scan is commonly used to examine a lump in a specific area, including checking its size and finding out what tissues and areas are nearby. It is often used to check the abdomen, back of the abdomen (retroperitoneum) and chest. If soft tissue sarcoma is diagnosed, a CT scan can be used to check if the cancer has spread to other parts of the body.

• #33 Diagnosis of soft tissue sarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/soft-tissue-sarcoma/diagnosis

  A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check your general health, often before a biopsy. […] Blood clotting (coagulation) tests check if your blood is clotting properly. Prothrombin time (PT), partial thromboplastin time (PTT) and international normalized ratio (INR) are common blood clotting tests. They are usually checked before a biopsy is done. […] An MRI is commonly used to examine a lump that doctors think may be a soft tissue sarcoma. It is often the first imaging test done for lumps in the arms or legs. An MRI can check the size of a tumour, what tissues and areas are nearby and if it has spread to other parts of the body. […] A CT scan is commonly used to examine a lump in a specific area, including checking its size and finding out what tissues and areas are nearby. It is often used to check the abdomen, back of the abdomen (retroperitoneum) and chest. If soft tissue sarcoma is diagnosed, a CT scan can be used to check if the cancer has spread to other parts of the body.

• #34 Molecular Diagnostics in Sarcoma… | College of American Pathologists

  https://www.cap.org/member-resources/articles/molecular-diagnostics-in-sarcoma-pathology

  Although malignant tumors of bone and soft tissue (i.e., sarcomas) are rare (approximately 1% of newly diagnosed cancers), they represent an outsized diagnostic challenge. This difficulty stems in part from the impressive diversity of these neoplasms which are comprised of at least 80 distinct types. Increasingly, pathologists employ molecular testing as an aid in sarcoma diagnosis. Currently, the mainstay methods for sarcoma diagnosis are morphology and immunohistochemistry (IHC). Indeed, the most recent WHO guidelines for Bone and Soft Tissue tumors emphasize the central diagnostic importance of morphology. In practice, morphologic evaluation of sarcomas often generates a differential diagnosis for which further evaluation by ancillary methods is required. To address these limitations, molecular testing (i.e., testing DNA and/or RNA) has become increasingly common in diagnostic testing pathways for sarcomas and is often required for clinical trial protocols.

• #35 Soft Tissue Sarcomas | Choose the Right Test

  https://arupconsult.com/content/soft-tissue-sarcomas

  Sarcomas are rare tumors that can arise from a variety of nonepithelial tissues, including soft tissues such as blood vessels, fat, muscles, and nerves. Correct identification of the specific type of tumor is important to ensure appropriate treatment and determine prognosis. Although morphology is the basis for diagnosis, laboratory testing, including immunohistochemistry, cytogenetics, and molecular genetics, may play an essential role in diagnosis and classification. Germline genetic testing may also be used in the evaluation of genetic syndromes associated with soft tissue sarcomas. […] Molecular genetic testing may be useful to support the diagnosis and classification of soft tissue sarcomas. Many soft tissue sarcoma subtypes exhibit cytogenetic and molecular abnormalities, including amplifications, deletions, recurrent translocations, or single base-pair substitutions. These abnormalities may be specific to certain types of sarcoma and therefore diagnostically important. Some sarcomas may also be associated with complex karyotypes. Laboratory testing techniques used in the molecular characterization of soft tissue sarcomas may include fluorescence in situ hybridization (FISH), next generation sequencing (NGS), and polymerase chain reaction (PCR).

• #36 Soft Tissue Sarcomas | Choose the Right Test

  https://arupconsult.com/content/soft-tissue-sarcomas

  Fluorescence in situ hybridization (FISH) testing is used to identify common translocations that can aid in the diagnosis of soft tissue sarcomas. Determination of the specific fusion partner can predict prognosis in certain sarcoma subtypes, but often FISH testing does not identify the translocation partner. […] Germline genetic testing may be recommended when patients have a personal or family history of suggestive findings, including soft tissue sarcomas, or if the histologic, immunohistochemical, or molecular features of the sarcoma suggest a possible genetic syndrome.

• #37 Soft Tissue Sarcomas | Choose the Right Test

  https://arupconsult.com/content/soft-tissue-sarcomas

  Sarcomas are rare tumors that can arise from a variety of nonepithelial tissues, including soft tissues such as blood vessels, fat, muscles, and nerves. Correct identification of the specific type of tumor is important to ensure appropriate treatment and determine prognosis. Although morphology is the basis for diagnosis, laboratory testing, including immunohistochemistry, cytogenetics, and molecular genetics, may play an essential role in diagnosis and classification. Germline genetic testing may also be used in the evaluation of genetic syndromes associated with soft tissue sarcomas. […] Molecular genetic testing may be useful to support the diagnosis and classification of soft tissue sarcomas. Many soft tissue sarcoma subtypes exhibit cytogenetic and molecular abnormalities, including amplifications, deletions, recurrent translocations, or single base-pair substitutions. These abnormalities may be specific to certain types of sarcoma and therefore diagnostically important. Some sarcomas may also be associated with complex karyotypes. Laboratory testing techniques used in the molecular characterization of soft tissue sarcomas may include fluorescence in situ hybridization (FISH), next generation sequencing (NGS), and polymerase chain reaction (PCR).

• #38 Soft Tissue Sarcomas | Choose the Right Test

  https://arupconsult.com/content/soft-tissue-sarcomas

  Sarcomas are rare tumors that can arise from a variety of nonepithelial tissues, including soft tissues such as blood vessels, fat, muscles, and nerves. Correct identification of the specific type of tumor is important to ensure appropriate treatment and determine prognosis. Although morphology is the basis for diagnosis, laboratory testing, including immunohistochemistry, cytogenetics, and molecular genetics, may play an essential role in diagnosis and classification. Germline genetic testing may also be used in the evaluation of genetic syndromes associated with soft tissue sarcomas. […] Molecular genetic testing may be useful to support the diagnosis and classification of soft tissue sarcomas. Many soft tissue sarcoma subtypes exhibit cytogenetic and molecular abnormalities, including amplifications, deletions, recurrent translocations, or single base-pair substitutions. These abnormalities may be specific to certain types of sarcoma and therefore diagnostically important. Some sarcomas may also be associated with complex karyotypes. Laboratory testing techniques used in the molecular characterization of soft tissue sarcomas may include fluorescence in situ hybridization (FISH), next generation sequencing (NGS), and polymerase chain reaction (PCR).

• #39 Soft Tissue Sarcomas | Choose the Right Test

  https://arupconsult.com/content/soft-tissue-sarcomas

  Laboratory testing for soft tissue sarcomas is appropriate in individuals with a biopsy specimen that is suspicious for sarcoma and requires additional information beyond what can be provided by a morphologic evaluation. […] For many soft tissue sarcomas, diagnosis and classification are based on histology and supported by immunohistochemical and molecular findings. Enough tissue should be obtained from biopsy or resection for histology, immunohistochemistry, and molecular testing. […] Immunohistochemistry testing aids in the diagnosis and classification of soft tissue sarcomas. […] Genetic tests on tumor samples may be useful in addition to histology and immunohistochemistry in diagnosis and classification, and may be particularly beneficial in unusual cases or when the diagnosis is not definitive. Genetic testing may also be useful in prognosis/risk stratification and treatment decision-making.

• #40 Soft Tissue Sarcomas | Choose the Right Test

  https://arupconsult.com/content/soft-tissue-sarcomas

  Laboratory testing for soft tissue sarcomas is appropriate in individuals with a biopsy specimen that is suspicious for sarcoma and requires additional information beyond what can be provided by a morphologic evaluation. […] For many soft tissue sarcomas, diagnosis and classification are based on histology and supported by immunohistochemical and molecular findings. Enough tissue should be obtained from biopsy or resection for histology, immunohistochemistry, and molecular testing. […] Immunohistochemistry testing aids in the diagnosis and classification of soft tissue sarcomas. […] Genetic tests on tumor samples may be useful in addition to histology and immunohistochemistry in diagnosis and classification, and may be particularly beneficial in unusual cases or when the diagnosis is not definitive. Genetic testing may also be useful in prognosis/risk stratification and treatment decision-making.

• #41 Benign and Malignant Soft-Tissue Tumors Workup: Laboratory Studies, Imaging Studies, Tissue Diagnosis

  https://emedicine.medscape.com/article/1253816-workup

  Several biopsy techniques are available, including the following: Fine-needle aspiration biopsy (FNAB), Core needle biopsy, Incisional biopsy, Excisional biopsy. […] The choice of biopsy technique is based on the size and location of the mass and the experience of the surgeon. […] Histologic grading is an important prognostic factor in sarcomas. Therefore, the usual tumor-node-metastases (TNM) scheme is modified into a grade-tumor-node-metastases (GTNM) scheme for classifying soft-tissue tumors. […] The GTNM system, which is clinically very useful, stratifies patients into groups with distinct prognostic patterns.

• #42 Soft Tissue Sarcoma Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/soft-tissue-sarcoma/soft-tissue-sarcoma-diagnosis.html

  If at all possible, your first biopsy should be at the cancer center where you will receive treatment. […] The pathologists at MD Anderson are highly specialized in diagnosing and staging every type of sarcoma. […] If you are diagnosed with sarcoma, your doctor will determine the stage (or extent) of the disease. […] Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis). […] The official staging system divides sarcomas into three grades (1 to 3). The grade of a sarcoma helps predict how rapidly it will grow and spread, as well as your outlook for successful treatment (prognosis). […] Higher-grade cancers tend to grow and spread faster than lower-grade cancers.

• #43 Soft Tissue Sarcoma Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/soft-tissue-sarcoma/soft-tissue-sarcoma-diagnosis.html

  If at all possible, your first biopsy should be at the cancer center where you will receive treatment. […] The pathologists at MD Anderson are highly specialized in diagnosing and staging every type of sarcoma. […] If you are diagnosed with sarcoma, your doctor will determine the stage (or extent) of the disease. […] Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis). […] The official staging system divides sarcomas into three grades (1 to 3). The grade of a sarcoma helps predict how rapidly it will grow and spread, as well as your outlook for successful treatment (prognosis). […] Higher-grade cancers tend to grow and spread faster than lower-grade cancers.

• #44 Sarcoma: What it Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17934-sarcoma

  Soft tissue sarcomas begin in the muscle or other connective tissues of your body. Unlike bone sarcomas, most soft tissue sarcomas occur in adults. Certain types of sarcoma, such as rhabdomyosarcoma, are found mostly in children. […] Your healthcare provider will begin with a thorough history and physical examination. They may perform special tests on a tissue sample obtained from a biopsy to diagnose the exact type of sarcoma you have. […] They may use any of the following tests when making a diagnosis: X-ray, Computed tomography (CT) scan, Magnetic resonance imaging (MRI), Bone scan, PET scan, Biopsy. […] Cancer staging is used to better understand how serious a sarcoma is and what treatments may work best. Providers classify most sarcoma based on the TNM classification system: T: Describes the size and location of the primary tumor. N: Describes whether the cancer has spread to nearby lymph nodes. M: Describes whether the cancer has spread to other organs (metastasized).

• #45 Benign and Malignant Soft-Tissue Tumors Workup: Laboratory Studies, Imaging Studies, Tissue Diagnosis

  https://emedicine.medscape.com/article/1253816-workup

  Several biopsy techniques are available, including the following: Fine-needle aspiration biopsy (FNAB), Core needle biopsy, Incisional biopsy, Excisional biopsy. […] The choice of biopsy technique is based on the size and location of the mass and the experience of the surgeon. […] Histologic grading is an important prognostic factor in sarcomas. Therefore, the usual tumor-node-metastases (TNM) scheme is modified into a grade-tumor-node-metastases (GTNM) scheme for classifying soft-tissue tumors. […] The GTNM system, which is clinically very useful, stratifies patients into groups with distinct prognostic patterns.

• #46 Soft Tissue Sarcoma Diagnosis | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/diagnosis

  Soft Tissue Sarcoma Diagnosis […] Getting an accurate diagnosis is crucial to getting the best care for soft tissue sarcoma. By making absolutely sure that we have diagnosed the correct sarcoma type, we can better determine the most effective treatment approach for you. […] Diagnosing soft tissue sarcoma is not straightforward. When people come to us for a second opinion, our pathologists change their diagnosis approximately 15 percent of the time. […] At MSK, we review your medical history, assess your overall health, and use imaging tests, such as CT and PET scans or MRI, to get a complete picture of the disease. […] Thats because an accurate diagnosis allows us to recommend the most-effective treatment possible. […] While these tests are very helpful, the gold standard for diagnosing soft tissue sarcoma is a biopsy. In this procedure, we take a tiny sample of the tumor so that a pathologist (a doctor who is specially trained to diagnose disease) can look at it under a microscope.

• #47 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk in: EFORT Open Reviews Volume 2 Issue 10 (2017)

  https://eor.bioscientifica.com/view/journals/eor/2/10/2058-5241.2.170005.xml

  Due to the complexity of treatment, any soft-tissue swelling suspected of malignancy is best referred directly to a sarcoma centre, where therapeutic management is carefully planned by an experienced multidisciplinary team. […] The diagnostic pathway should always start with a thorough documentation of the patients history. Lumps that have not changed in size or shape over the years are most likely benign, whereas recently noticed, constantly-enlarging swellings should urge caution. […] In cases of STS, however, pain is a rather poor discriminator between benign and malignant lesions. […] As the majority of STSs are located deep to the fascia, every deeply-situated tumour should be considered malignant until proven otherwise. […] The chief objectives of imaging are to confirm clinical findings by detecting a soft-tissue mass, to estimate its size, tissue quality and relation to adjacent structures in detail, and to aid planning of the further course of action.

• #48 Soft Tissue Sarcoma: Diagnosis and Treatment | MDedge

  https://blogs.the-hospitalist.org/content/soft-tissue-sarcoma-diagnosis-and-treatment

  Soft tissue sarcomas (STSs) are rare adult tumors, with 3.4 new cases per 100,000 persons or 12,310 expected new cases in 2016. Treatment varies by stage, with limb-sparing surgery representing the mainstay of curative-intent treatment. […] Given the complexity of these cases, all patients ideally should be evaluated and treated by a multidisciplinary team at an institution with extensive experience treating STS. […] Imaging should be undertaken to help differentiate between benign and malignant lesions. Ideally, it should be undertaken before a biopsy is planned as the imaging can be used to plan biopsy as well as provide invaluable prognostic information. […] The American Joint Committee on Cancer (AJCC) staging system is the most widely used staging system in the United States. […] Prognostic factors include grade, size, and presence of metastases at presentation. Best survival is associated with low-grade, small tumors with no metastases at time of diagnosis.

• #49 Soft tissue sarcomas of the extremities: How to stay out of trouble | British Columbia Medical Journal

  https://bcmj.org/articles/soft-tissue-sarcomas-extremities-how-stay-out-trouble

  Although the majority of soft tissue masses are benign, it is important to consider malignancy in the differential diagnosis. […] MRI is the standard imaging modality for investigating possibly malignant masses. Local and systemic staging are essential for prognostication and subsequent management. […] An appropriately planned and executed biopsy of a soft tissue mass can help prevent misdiagnosis, increased mortality, and lost opportunities for limb salvage surgery. […] Failure to recognize a sarcoma in the primary care setting and refer a patient appropriately can result in lost opportunities for limb salvage and increased mortality for the patient. […] Improved outcomes in soft tissue sarcomas managed in a multidisciplinary environment have been well documented, and it has also been shown that patients receiving biopsies or surgical interventions prior to referral to a multidisciplinary centre have inferior outcomes.

• #50 Soft tissue sarcomas of the extremities: How to stay out of trouble | British Columbia Medical Journal

  https://bcmj.org/articles/soft-tissue-sarcomas-extremities-how-stay-out-trouble

  Although the majority of soft tissue masses are benign, it is important to consider malignancy in the differential diagnosis. […] MRI is the standard imaging modality for investigating possibly malignant masses. Local and systemic staging are essential for prognostication and subsequent management. […] An appropriately planned and executed biopsy of a soft tissue mass can help prevent misdiagnosis, increased mortality, and lost opportunities for limb salvage surgery. […] Failure to recognize a sarcoma in the primary care setting and refer a patient appropriately can result in lost opportunities for limb salvage and increased mortality for the patient. […] Improved outcomes in soft tissue sarcomas managed in a multidisciplinary environment have been well documented, and it has also been shown that patients receiving biopsies or surgical interventions prior to referral to a multidisciplinary centre have inferior outcomes.

• #51 Soft Tissue Sarcoma Diagnosis | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/diagnosis

  In fact, when our pathologists are asked for a second opinion about soft tissue sarcoma, we change the diagnosis about 15 percent of the time. […] We use genetic and molecular sequencing on the tumors of nearly all our patients with soft tissue sarcoma. By making absolutely sure that we have diagnosed the correct sarcoma type, we can better determine the most effective treatment approach. […] Staging soft tissue sarcoma involves identifying the location of the tumor and how far it may have spread. Once the tumor is staged, we can design a personalized treatment strategy for you.

• #52 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk in: EFORT Open Reviews Volume 2 Issue 10 (2017)

  https://eor.bioscientifica.com/view/journals/eor/2/10/2058-5241.2.170005.xml

  Magnetic resonance imaging (MRI) is the method of choice to evaluate soft-tissue tumours and to distinguish benign from malignant lesions, especially if prior clinical findings and imaging were inconclusive. […] This is an essential part of the diagnostic pathway for soft-tissue tumours. […] The histological classification of STSs is an integral part of the diagnostic pathway. Personalised and targeted treatment approaches warrant precise sub-classification into one of more than 117 different soft-tissue tumours defined in the recent WHO Classification of Bone and Soft Tissue Tumours. […] The most common type is high-grade pleomorphic sarcoma, followed by liposarcoma which itself comprises several sub-types leiomyosarcoma, synovial sarcoma and MPNST. […] The diagnosis of STS can be challenging. A thorough diagnostic workup is usually required to distinguish malignant from benign soft-tissue lesions. If performed only partially or inaccurately, misinterpretation of the underlying pathology at best delays ultimate diagnosis. […] Consequently, unplanned excisions may be performed, necessitating extensive re-resection and adjuvant therapy at tumour centres.

• #53 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5702952/

  Pain assessment is important in every physician-patient consultation. In cases of STS, however, pain is a rather poor discriminator between benign and malignant lesions. […] As a readily accessible and inexpensive imaging technique, ultrasound (US) is ideal for the initial evaluation of a soft-tissue mass. […] Magnetic resonance imaging (MRI) is the method of choice to evaluate soft-tissue tumours and to distinguish benign from malignant lesions, especially if prior clinical findings and imaging were inconclusive. […] This is an essential part of the diagnostic pathway for soft-tissue tumours. […] The histological classification of STSs is an integral part of the diagnostic pathway. […] The diagnosis of STS can be challenging. A thorough diagnostic workup is usually required to distinguish malignant from benign soft-tissue lesions. If performed only partially or inaccurately, misinterpretation of the underlying pathology at best delays ultimate diagnosis. Consequently, unplanned excisions may be performed, necessitating extensive re-resection and adjuvant therapy at tumour centres. […] In order to avoid misdiagnoses, one should follow a standardised diagnostic approach, beginning with the patient history, clinical examination and appropriate imaging prior to conducting biopsy.

• #54 Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5702952/

  Pain assessment is important in every physician-patient consultation. In cases of STS, however, pain is a rather poor discriminator between benign and malignant lesions. […] As a readily accessible and inexpensive imaging technique, ultrasound (US) is ideal for the initial evaluation of a soft-tissue mass. […] Magnetic resonance imaging (MRI) is the method of choice to evaluate soft-tissue tumours and to distinguish benign from malignant lesions, especially if prior clinical findings and imaging were inconclusive. […] This is an essential part of the diagnostic pathway for soft-tissue tumours. […] The histological classification of STSs is an integral part of the diagnostic pathway. […] The diagnosis of STS can be challenging. A thorough diagnostic workup is usually required to distinguish malignant from benign soft-tissue lesions. If performed only partially or inaccurately, misinterpretation of the underlying pathology at best delays ultimate diagnosis. Consequently, unplanned excisions may be performed, necessitating extensive re-resection and adjuvant therapy at tumour centres. […] In order to avoid misdiagnoses, one should follow a standardised diagnostic approach, beginning with the patient history, clinical examination and appropriate imaging prior to conducting biopsy.

• #55 Soft tissue sarcoma: Recognizing a rare disease | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/2/73

  A smaller tumor at diagnosis ( 5 cm) is associated with better prognosis. […] Increasing size is the best individual indicator of a greater risk of malignancy. […] According to guidelines, a patient with a concerning lump or mass that is increasing in size, larger than 5 cm, in the deep fascia, and painful should be referred immediately to a sarcoma center for further evaluation, even if the risk of malignancy is only 3% to 4%. […] A high degree of suspicion for STS based on the biopsy results should trigger prompt referral to a sarcoma center for triple assessment of clinical history, imaging, and biopsy, all of which should be done on the same day. […] Effective management of patients with suspected STS requires practitioners to be aware of the signs and symptoms and to know the appropriate testing procedures.

• #56 Soft tissue sarcoma: clinical recognition and approach to the loneliest cancer

  https://www.explorationpub.com/Journals/emd/Article/100734

  Soft tissue sarcoma (STS) is a rare malignancy with a high incidence. Early diagnosis can reduce the rate of amputations and increase survival, however, this is typically delayed. […] A timely and precise diagnosis is essential because half of people with STS progress toward quietly aggressive illness. […] The purpose of this review is to raise awareness of STSs so that early recognition, accurate work-up, overview of conventional treatment plans, and appropriate referral to a tumor center can be achieved, avoiding whoop situations, and improving patient outcomes. […] The clinical symptoms observed in patients with STS are nonspecific, with the most common finding being a painless, gradually enlarging mass with site-dependent symptoms of increased pressure, such as paraesthesia and distal edema.

• #57 Soft tissue sarcoma: Recognizing a rare disease | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/2/73

  The recognition of a malignant soft tissue mass can be challenging, given the rarity of soft tissue sarcoma and the extensive overlap between benign and malignant presentations. […] Awareness of the signs and symptoms of soft tissue sarcoma in primary care practice ensures prompt referral to a sarcoma center for appropriate assessment and treatment to optimize outcomes. […] The rarity of soft tissue sarcoma, its heterogeneity, and overlap of symptoms with benign conditions are challenges to timely diagnosis. […] Patients suspected of having a soft tissue sarcoma require prompt referral to a sarcoma center for assessment and treatment. […] Early recognition of the signs and symptoms of soft tissue sarcoma (STS) and prompt referral to a center with expertise in STS are essential to ensure effective multidisciplinary team management and optimize outcome.

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