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Semin Musculoskelet Radiol. 2015 Dec;19(5):475-82. doi: 10.1055/s-0035-1569251. Epub 2015 Dec 22.

Soft Tissue Tumors in Adults: ESSR-Approved Guidelines for Diagnostic Imaging.

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Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Austria.
Diagnostic and Interventional Radiology, University Hospital Heidelberg Im Neuenheimer Feld, Heidelberg, Germany.
Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom.
Department of Radiology, General Hospital Sint-Maarten, Duffel-Mechelen, Universities of Antwerp and Ghent, Duffel, Belgium.
Department of Experimental Medicine -DIMES-, Institute of Anatomy, University of Genova, Genova, Italy.
Department of Radiology, Leiden University Medical Center, the Netherlands.
ClĂ­nica Girona, Institut Catalan of Health-IDI, University of Girona, Girona, Spain.
Hospital Beatriz Angelo, Lisbon, Portugal.
Orthopedic Surgery, Radiology, Landesklinikum Horn, Horn, Austria.
Department of Radiology, Royal Infirmary, Edinburgh, United Kingdom.
Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, United Kingdom.
Department of Radiology, Zuwe Hofpoort Hospital, Woerden, the Netherlands.


Soft tissue sarcomas are rare, but early, accurate diagnosis with subsequent appropriate treatment is crucial for the clinical outcome. The ESSR guidelines are intended to help radiologists in their decision-making and support discussion among clinicians who deal with patients with suspected or proven soft tissue tumors. Potentially malignant lesions recognized by ultrasound should be referred for magnetic resonance imaging (MRI), which also serves as a preoperative local staging modality, with specific technical requirements and mandatory radiological report elements. Radiography may add information about matrix calcification and osseous involvement. Indeterminate lesions, or lesions in which therapy is dependent on histology results, should be biopsied. For biopsy, we strongly recommend referral to a specialist sarcoma center, where an interdisciplinary tumor group, with a specialized pathologist, radiologist, and the surgeon are involved. In sarcoma, a CT scan of the chest is mandatory. Additional staging modalities are entity-specific. There are no evidence-based recommendations for routine follow-up in surgically treated sarcomas. However, we would recommend regular follow-up with intervals dependent on tumor grade, for 10 years after the initial diagnosis.

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