The value of re-staging chest CT at first local recurrence of extremity and trunk soft tissue sarcoma
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COMPUTED TOMOGRAPHY
The value of re-staging chest CT at first local recurrence of extremity and trunk soft tissue sarcoma Mirza S. Baig 1
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& Wais Habib & Veronica Attard & Ban Sharif & Daniel Lindsay & Bhavin Upadhyay & Asif Saifuddin
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Received: 11 June 2020 / Revised: 6 September 2020 / Accepted: 1 October 2020 # European Society of Radiology 2020
Abstract Objective To determine the prevalence of pulmonary metastases on re-staging chest CT at the time of first local recurrence (LR) of trunk or extremity soft tissue sarcoma (STS). Materials and methods Retrospective review of all patients diagnosed with recurrent STS between May 2007 and April 2018. Data collected included patient age and sex, site of primary STS, time to LR, recurrence site, initial tumour grade, recurrent tumour grade, findings of initial staging chest CT, and prevalence of pulmonary metastases on re-staging chest CT. Results The study included 109 patients (males = 68, females = 41; mean age 56 years, range 9–92 years). The commonest tumour sub-types were myxofibrosarcoma (27.5%), undifferentiated pleomorphic/spindle cell sarcoma (20.2%), synovial sarcoma (10.1%), and malignant peripheral nerve sheath tumour (10.1%). Initial staging chest CT demonstrated pulmonary metastases in 1 of 77 (1.3%) patients for whom CT was available for review. The mean time to LR was 30.8 months (range 3– 224 months). Pulmonary metastases were diagnosed on re-staging chest CT in 26 of 109 cases (23.9%), being commonest with grade 3 STS (36.1%). Pleomorphic sarcoma (85.7%) and undifferentiated spindle cell sarcoma (33.3%) were the 2 commonest tumour sub-types associated with pulmonary metastases at first LR. Conclusion Re-staging chest CT at the time of first LR of STS identified a prevalence of 23.9% pulmonary metastases, which supports the need for chest CT at the time of LR in line with the UK guidelines for the management of bone and soft tissue sarcoma. Key Points • Pulmonary metastases were diagnosed in 1.3% of soft tissue sarcomas at presentation. • Pulmonary metastases were identified in ~ 24% of patients at first local recurrence of soft tissue sarcoma, most commonly with pleomorphic sarcoma and Trojani grade tumours. • No patient with a low-grade recurrence had pulmonary metastases. Keywords Neoplasm Recurrence, Local . Sarcoma . Neoplasm metastasis . Tomography, X-ray computed
* Mirza S. Baig [email protected] 1
Queen Elizabeth Hospital Critical Care, Lewisham and Greenwich NHS Trust, Stadium Road, Woolwich, London SE18 4QH, UK
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Barts and the London School of Medicine and Dentistry, Garrod Building, Turner St, Whitechapel, London E1 2AD, UK
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Department of Medical Imaging, Mater Dei Hospital, Triq Dun Karm, L-Imsida MSD2090, Malta
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Radiology Department, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK
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Department of Histopathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
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Department of Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
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