To investigate the accuracy of ultrasound in characterising the type of mass and likelihood of malignancy in deep soft tissue masses.
Five hundred seventy-nine deep soft tissue masses were prospectively studied by ultrasound. Masses (n = 137) with prior MRI or CT were not included. Following ultrasound examination, the likely nature of the mass as well as the confidence of the reporting radiologist (‘fully confident’ versus ‘not fully confident’) about the ultrasound diagnosis was recorded. Clinical and ultrasound diagnoses were compared with the histological diagnosis which was available in 134 (23%) of the 579 masses.
Compared with histology, clinical and ultrasound accuracy for characterising the type of mass were 47% and 88% respectively when all differential diagnoses were considered. The radiologist was fully confident regarding the type of 436 (75%) of 579 masses and, in this setting, for those cases that could be compared with histology, diagnostic accuracy was 96%. For the remaining masses, where the radiologist was not fully confident, accuracy compared with histology was 58% for the first differential diagnosis and 80% for all differential diagnoses. For identifying malignancy, sensitivity, specificity, and positive and negative predictive value of ultrasound were 97%, 58%, 67%, and 99% respectively. Ultrasound alone was considered sufficient for diagnostic workup in over half of all deep soft tissue masses.
Ultrasound is useful at characterising and recognising malignancy in deep soft tissue masses. Provided local practice patterns are favourable, ultrasound may be considered a first-line investigation in the diagnostic workup of deep soft tissue masses.
• In three-quarters of cases, one can be fully confident about characterising the nature of deep soft tissue masses on ultrasound and, for those fully confident cases that could be compared with histology, the diagnostic accuracy of ultrasound was 96%.
• Ultrasound can correctly recognise nearly all malignant deep soft tissue masses but some benign masses will also be considered possibly malignant.
• Ultrasound alone was considered sufficient for imaging workup in over half of deep soft tissue masses.
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American College of Radiology
European Society of Musculoskeletal Radiology
Giant cell tumour of tendon sheath
Negative predictive value
Positive predictive value
Kransdorf MJ, Murphey MD (2016) Imaging of soft-tissue musculoskeletal masses: fundamental concepts. Radiographics. 36(6):1931–1948
Wu JS, Hochman MG (2009) Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology 253(2):297–316
Hung EH, Griffith JF, Ng AW, Lee RK, Lau DT, Leung JC (2014) Ultrasound of musculoskeletal soft-tissue masses superficial to the investing fascia. AJR Am J Roentgenol 202(6):W532–W540
Ahlawat S, Corl FM, LaPorte DM, Fishman EK, Fayad LM (2017) MDCT of hand and wrist infections: emphasis on compartmental anatomy. Clin Radiol 72(4):338.e1–338.e9
Saifuddin A, Siddiqui S, Pressney I, Khoo M (2020) The incidence and diagnostic relevance of chemical shift artefact in the magnetic resonance imaging characterisation of superficial soft tissue masses. Br J Radiol 93(1108):20190828
Lakkaraju A, Sinha R, Garikipati R, Edward S, Robinson P (2009) Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol 64(6):615–621
Beaman FD, Kransdorf MJ, Andrews TR, Murphey MD, Arcara LK, Keeling JH (2007) Superficial soft-tissue masses: analysis, diagnosis, and differential considerations. Radiographics 27(2):509–523
Balach T, Stacy GS, Haydon RC (2011) The clinical evaluation of soft tissue tumors. Radiol Clin North Am 49(6):1185–1196
Noebauer-Huhmann IM, Weber MA, Lalam RK et al (2015) Soft tissue tumors in adults: ESSR-approved guidelines for diagnostic imaging. Semin Musculoskelet Radiol 19(5):475–482
Kransdorf MJ, Murphey MD, Wessell DE et al (2018) ACR appropriateness criteria(®) soft-tissue masses. J Am Coll Radiol 15(5S):S189–S197
Hung EH, Griffith JF (2014) Pitfalls in ultrasonography of soft tissue masses. Semin Musculoskelet Radiol 18(1):79–85
Taljanovic MS, Gimber LH, Klauser AS, Porrino JA, Chadaz TS (2017) Ultrasound in the evaluation of musculoskeletal soft-tissue masses. Semin Roentgenol 52(4):241–254
Carra BJ, Bui-Mansfield LT, O'Brien SD, Chen DC (2014) Sonography of musculoskeletal soft-tissue masses: techniques, pearls, and pitfalls. AJR Am J Roentgenol 202(6):1281–1290
Belli P, Costantini M, Mirk P, Maresca G, Priolo F, Marano P (2000) Role of color Doppler sonography in the assessment of musculoskeletal soft tissue masses. J Ultrasound Med 19(12):823–830
Bodner G, Schocke MF, Rachbauer F et al (2002) Differentiation of malignant and benign musculoskeletal tumors: combined color and power Doppler US and spectral wave analysis. Radiology 223(2):410–416
Griffith JF, Chan DP, Kumta SM, Chow LT, Ahuja AT (2004) Does Doppler analysis of musculoskeletal soft-tissue tumours help predict tumour malignancy? Clin Radiol 59(4):369–375
Widmann G, Riedl A, Schoepf D, Glodny B, Peer S, Gruber H (2009) State-of-the-art HR-US imaging findings of the most frequent musculoskeletal soft-tissue tumors. Skeletal Radiol 38(7):637–649
Loizides A, Peer S, Plaikner M, Djurdjevic T, Gruber H (2012) Perfusion pattern of musculoskeletal masses using contrast-enhanced ultrasound: a helpful tool for characterisation? Eur Radiol 22(8):1803–1811
Nagano S, Yahiro Y, Yokouchi M et al (2015) Doppler ultrasound for diagnosis of soft tissue sarcoma: efficacy of ultrasound-based screening score. Radiol Oncol 49(2):135–140
Gruber L, Loizides A, Ostermann L, Glodny B, Plaikner M, Gruber H (2016) Does size reliably predict malignancy in soft tissue tumours? Eur Radiol 26(12):4640–4648
Morii T, Kishino T, Shimamori N, Motohashi M, Ohnishi H, Honya K et al (2018) Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters. J Med Ultrason 45(1):113–119
Tavare AN, Alfuraih AM, Hensor EMA, Astrinakis E, Gupta H, Robinson P (2019) Shear-wave elastography of benign versus malignant musculoskeletal soft-tissue masses: comparison with conventional US and MRI. Radiology 290(2):410–417
Charnock M, Kotnis N, Fernando M, Wilkinson V (2018) An assessment of ultrasound screening for soft tissue lumps referred from primary care. Clin Radiol 73(12):1025–1032
Wu S, Tu R, Liu G, Shi Y (2013) Role of ultrasound in the diagnosis of common soft tissue lesions of the limbs. Ultrasound Q 29(1):67–71
Slaisova R, Benda K, Jarkovsky J, Petrasova H, Szturz P, Valek V (2013) Contrast-enhanced ultrasonography compared to gray-scale and power doppler in the diagnosis of peripheral lymphadenopathy. Eur J Radiol 82(4):693–698
Lee RK, Griffith JF, Ng WH (2015) High accuracy of ultrasound in diagnosing the presence and type of groin hernia. J Clin Ultrasound 43(9):538–547
Wagner JM, Rebik K, Spicer PJ (2019) Ultrasound of soft tissue masses and fluid collections. Radiol Clin North Am 57(3):657–669
Fletcher CD (2014) The evolving classification of soft tissue tumours - an update based on the new 2013 WHO classification. Histopathology 64(1):2–11
Hung EHY, Griffith JF, Yip SWY et al (2020) Accuracy of ultrasound in the characterization of superficial soft tissue masses: a prospective study. Skeletal Radiol 49(6):883–892
Wortsman X, Wortsman J (2015) Ultrasound accuracy in the diagnosis of skin and soft-tissue lesions. AJR Am J Roentgenol 204(2):W220
Wagner JM, Lee KS, Rosas H, Kliewer MA (2013) Accuracy of sonographic diagnosis of superficial masses. J Ultrasound Med 32(8):1443–1450
Sprague BL, Arao RF, Miglioretti DL et al (2017) National performance benchmarks for modern diagnostic digital mammography: update from the breast cancer surveillance consortium. Radiology 283(1):59–69
Gielen JL, De Schepper AM, Vanhoenacker F et al (2004) Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions. A prospective study in 548 patients. Eur Radiol 14(12):2320–2330
Del Grande F, Ahlawat S, Subhangwong T, Fayad LM (2017) Characterization of indeterminate soft tissue masses referred for biopsy: what is the added value of contrast imaging at 3.0 tesla? J Magn Reson Imaging 45(2):390–400
Subhawong TK, Wang X, Durand DJ et al (2012) Proton MR spectroscopy in metabolic assessment of musculoskeletal lesions. AJR Am J Roentgenol 198(1):162–172
Lee SY, Jee WH, Jung JY et al (2016) Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion weighted MR imaging to standard MR imaging at 3.0 T. Eur Radiol 26(3):743–754
Bancroft LW, Pettis C, Wasyliw C (2013) Imaging of benign soft tissue tumors. Semin Musculoskelet Radiol 17(2):156–167
The authors state that this work has not received any funding.
The scientific guarantor of this publication is Prof. James Francis Griffith.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Jason Leung from The Chinese University of Hong Kong kindly provided statistical advice for this manuscript.
Jason Leung is one of the authors who has significant statistical expertise.
Written informed consent was not required for this study because patients underwent a clinically indicated ultrasound examination with no additional imaging, procedure, or change in clinical management.
Institutional Review Board approval was obtained.
• cohort study
• performed at one institution
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Griffith, J.F., Yip, S.W.Y., Hung, E.H.Y. et al. Accuracy of ultrasound in the characterisation of deep soft tissue masses: a prospective study. Eur Radiol (2020). https://doi.org/10.1007/s00330-020-07002-5
- Soft tissue neoplasms
- Tumour burden
- Ultrasound imaging
- Data accuracy