The value of re-staging chest CT at first local recurrence of extremity and trunk soft tissue sarcoma

• Published in: European radiology 2021-04, Vol.31 (4), p.2377-2383
• Main Authors: Baig, Mirza S., Habib, Wais, Attard, Veronica, Sharif, Ban, Lindsay, Daniel, Upadhyay, Bhavin, Saifuddin, Asif
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Chest; Child; Computed Tomography; Diagnostic Radiology; Extremities - diagnostic imaging; Female; Humans; Imaging; Internal Medicine; Interventional Radiology; Male; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neuroradiology; Patients; Peripheral nerves; Radiology; Retrospective Studies; Sarcoma; Sarcoma - diagnostic imaging; Sheaths; Soft Tissue Neoplasms - diagnostic imaging; Soft tissue sarcoma; Soft tissues; Synovial sarcoma; Tissues; Tomography, X-Ray Computed; Tumors; Ultrasound; Young Adult
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-020-07366-8

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.