1. | Progressive growth of tumor clinically (particularly if growth is rapid and patient has or had known primary tumor) |
2. | Middle-aged or elderly patient |
3. | Medium to large-sized tumor (>2 cm if superficial), (>3 cm if deep) |
4. | Moderate to severe tumor hyperemia (if superficial) Mild to moderate tumor hyperemia (if deep) |
5. | More rounded, rather than elongated, tumor shape |
6. | Chaotic, rather than organized, tumoral vascular pattern |
7. | Lack of similarity with the known US appearances of particular benign soft tissue masses |
Superficial masses | Deep masses | |
---|---|---|
823 | 579 | |
585 (71%) | 436 (75%) | |
219/823 (27%) | 134/579 (34%) | |
132/219 (60%) | 67/134 (57%) | |
126/132 (95%) | 64/67 (96%) | |
Incorrect confident diagnosis for Glomus tumor considered to be nerve sheath tumor Dermoid cyst considered to be infected collection Vascular leiomyoma considered to be vascular anomaly Vascular anomaly considered to be lipoma Neurofibroma considered to be epidermoid cyst Calcified metastatic deposit considered to be calcified granuloma |
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Incorrect confident diagnosis for Giant cell tumor of tendon sheath (GCTTS) considered to be ganglion Vascular malformation considered to be intra-fascial lipoma Organized inflammatory mass considered to be lipoma |
Confident regarding diagnosis | Indeterminate mass with no evidence of malignancy | Indeterminate mass with possibility of malignancys |
---|---|---|
Provide definitive diagnosis. If benign, no need for additional investigation in most instances. If considered malignant, proceed to: percutaneous biopsy ± MRI. |
List three most likely diagnoses ± comment that tumor is much more likely to be benign rather than malignant. Proceed to either:
percutaneous biopsy excisional biopsy MRI examination follow-up ultrasound |
Proceed to:
percutaneous biopsy ± MRI examination |
Superficial | Deep | ||
---|---|---|---|
Lipoma and variants |
Epidermoid cyst |
Lipoma and variants |
Elastofibroma dorsi |
Vascular anatomy |
Inflammatory mass |
GCTTS |
Ganglion |
Nerve sheath tumors |
Foreign body granuloma |
Plantar or palmar fibroma |
Bakers’ cyst |
Pilomatrixoma |
Calcified or injection granuloma |
Fibromatosis (desmoid tumor) |
Hernia |
Lymph node |
Fat necrosis |
Myxoma |
Gouty tophus |
Leiomyoma |
Rheumatoid nodule |
Sarcoma |
Hematoma |
Subcutaneous lymphoma |
Panniculitis-like mass |
Subcutaneous lymphoma |
Varix, pseudoaneurysm, aneurysm |
Lymphocele |
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Lipohypertrophy/lipomatosis |
Myositis ossificans |
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Encysted fluid spermatic cord/canal of Nuck |
Muscle hypertrophy |
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Abscess or collection |
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Intravascular papillary epithelial | Morton’s neuroma |
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hypertrophy |
Bursitis |
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Organizing hematoma |
Endometriosis |
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Tumoral calcinosis |
Xanthoma |
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Accessory breast issue |
More global, encompassing assessment Anatomical road map to excision Appreciation of extent of large ill-defined tumor, such as vascular malformation Delineation of medium or large deep-seated mass Delineation of large mass in anatomically complex areas such as the wrist or mid-foot Delineation of mass in any area where transducer access is limited Assessment of peritumoral and muscle edema Delineation of neurovascular infiltration Delineation of bone and joint involvement Tumor tissue composition Tumor characterization occasionally Monitoring chemotherapy response (functional imaging) Surveillance for STS tumor recurrence (± functional imaging) |