Skip to main content
Top
Published in: Insights into Imaging 2/2012

Open Access 01-04-2012 | Original Article

Grading and characterization of soft tissue tumors on magnetic resonance imaging: the value of an expert second opinion report

Authors: F. M. Vanhoenacker, K. Van Looveren, K. Trap, J. Desimpelaere, K. Wouters, P. Van Dyck, P. M. Parizel, A. M. De Schepper

Published in: Insights into Imaging | Issue 2/2012

Login to get access

Abstract

Objective

To retrospectively compare the accuracy of the initial MRI (magnetic resonance imaging) report of referring radiologists and the second opinion report.

Material and methods

MRI of 155 patients presenting with a soft tissue tumor (STT) in a single large community center were referred for inclusion in the Belgian Soft Tissue Neoplasm Registry (BSTNR). The initial report and the second opinion report were made independently. Histopathology (gold standard) was obtained in 90 patients (group 1). In 65 patients, the diagnosis was made by the combination of clinical findings and/or follow-up (group 2). In group 1, the concordance in grading and tissue-specific (TS) diagnosis between the referring center (RC) and expert center (EC) was reviewed.

Results

In group 1, MR grading yields a sensitivity of 100% and a specificity of 89% in the EC. The sensitivity was 88% and the specificity 81% in the RC. The accuracy was significantly higher in the EC (92%) compared to the RC (83%) (p = 0.039). The TS diagnosis was correct in 50% versus 38.5% of malignant tumors and in 71.8% versus 51.6% of benign tumors in the EC and RC respectively.

Conclusion

A second opinion report increases the accuracy in the diagnosis of STT on MRI.

Main Messages

A second opinion MRI report increases the overall accuracy in the diagnosis of soft tissue tumors.
There is a good overall agreement in MR grading between the referring and expert institution.
In the expert center, there were fewer false-negative and false-positive diagnoses.
MRI performs better in the tissue-specific diagnosis of benign versus malignant STT.
Literature
3.
go back to reference Cormier B, Bonneau C, Kerdraon R, Heitzmann A, Garnaud S, Michenet P (2007) Request of second opinion for difficult diagnosis in surgical pathology. Assessment of a one year activity in a general hospital. Ann Pathol 27:345–351PubMedCrossRef Cormier B, Bonneau C, Kerdraon R, Heitzmann A, Garnaud S, Michenet P (2007) Request of second opinion for difficult diagnosis in surgical pathology. Assessment of a one year activity in a general hospital. Ann Pathol 27:345–351PubMedCrossRef
4.
go back to reference Randall RL, Bruckner JD, Papenhausen MD, Thurman T, Conrad EU 3rd (2004) Errors in diagnosis and margin determination of soft-tissue sarcomas initially treated at non-tertiary centers. Orthopedics 27:209–212PubMed Randall RL, Bruckner JD, Papenhausen MD, Thurman T, Conrad EU 3rd (2004) Errors in diagnosis and margin determination of soft-tissue sarcomas initially treated at non-tertiary centers. Orthopedics 27:209–212PubMed
5.
7.
go back to reference Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM (1990) Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR Am J Roentgenol 155:1251–1255PubMedCrossRef Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM (1990) Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR Am J Roentgenol 155:1251–1255PubMedCrossRef
8.
go back to reference Ma LD, Frassica FJ, McCarthy EF, Bluemke DA, Zerhouni EA (1997) Benign and malignant musculoskeletal masses: MR imaging differentiation with rim-to-center differential enhancement ratios. Radiology 202:739–744PubMedCrossRef Ma LD, Frassica FJ, McCarthy EF, Bluemke DA, Zerhouni EA (1997) Benign and malignant musculoskeletal masses: MR imaging differentiation with rim-to-center differential enhancement ratios. Radiology 202:739–744PubMedCrossRef
9.
go back to reference Moulton JS, Blebea JS, Dunco DM, Braley SE, Bisset GS 3rd, Emery KH (1995) MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. AJR Am J Roentgenol 164:1191–1199PubMedCrossRef Moulton JS, Blebea JS, Dunco DM, Braley SE, Bisset GS 3rd, Emery KH (1995) MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. AJR Am J Roentgenol 164:1191–1199PubMedCrossRef
10.
go back to reference De Schepper AM, Vanhoenacker F, Gielen J, Parizel PM (2006) Imaging of soft tissue tumors, 3rd edn. Springer-Verlag, Berlin Heidelberg New YorkCrossRef De Schepper AM, Vanhoenacker F, Gielen J, Parizel PM (2006) Imaging of soft tissue tumors, 3rd edn. Springer-Verlag, Berlin Heidelberg New YorkCrossRef
11.
go back to reference Fletcher CDM, Unni KK, Mertens F (2002) World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. International Agency for Research on Cancer. IARC press, Lyon Fletcher CDM, Unni KK, Mertens F (2002) World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. International Agency for Research on Cancer. IARC press, Lyon
13.
go back to reference Metzler JP, Fleckenstein JL, Vuitch F, Frenkel EP (1992) Skeletal muscle lymphoma: MRI evaluation. Magn Reson Imaging 10:491–494PubMedCrossRef Metzler JP, Fleckenstein JL, Vuitch F, Frenkel EP (1992) Skeletal muscle lymphoma: MRI evaluation. Magn Reson Imaging 10:491–494PubMedCrossRef
14.
go back to reference Vanhoenacker FM, Baten A, Vandeputte V (2009) Imaging findings of a cutaneous B-cell lymphoma. JBR-BTR 92:285–288PubMed Vanhoenacker FM, Baten A, Vandeputte V (2009) Imaging findings of a cutaneous B-cell lymphoma. JBR-BTR 92:285–288PubMed
16.
go back to reference Moulopoulos LA, Dimopoulos MA, Vourtsi A, Gouliamos A, Vlahos L (1999) Bone lesions with soft-tissue mass: magnetic resonance imaging diagnosis of lymphomatous involvement of the bone marrow versus multiple myeloma and bone metastases. Leuk Lymphoma 34:179–184. doi:10.3109/10428199909083395PubMed Moulopoulos LA, Dimopoulos MA, Vourtsi A, Gouliamos A, Vlahos L (1999) Bone lesions with soft-tissue mass: magnetic resonance imaging diagnosis of lymphomatous involvement of the bone marrow versus multiple myeloma and bone metastases. Leuk Lymphoma 34:179–184. doi:10.​3109/​1042819990908339​5PubMed
17.
go back to reference Verelst W, Huygh J, Gielen JL, De Schepper AM (2007) Casus: een man met pijn ter hoogte van linkerschouder. Ortho-Rheumato 5:115–117 Verelst W, Huygh J, Gielen JL, De Schepper AM (2007) Casus: een man met pijn ter hoogte van linkerschouder. Ortho-Rheumato 5:115–117
18.
go back to reference Sundaram M, Sharafuddin MJ (1995) MR imaging of benign soft-tissue masses. Magn Reson Imaging Clin N Am 3:609–627PubMed Sundaram M, Sharafuddin MJ (1995) MR imaging of benign soft-tissue masses. Magn Reson Imaging Clin N Am 3:609–627PubMed
19.
go back to reference Vandevenne JE, De Schepper AM, De Beuckeleer L et al (1997) New concepts in understanding evolution of desmoid tumors: MR imaging of 30 lesions. Eur Radiol 7:1013–1019PubMedCrossRef Vandevenne JE, De Schepper AM, De Beuckeleer L et al (1997) New concepts in understanding evolution of desmoid tumors: MR imaging of 30 lesions. Eur Radiol 7:1013–1019PubMedCrossRef
20.
go back to reference Robbin MR, Murphey MD, Temple HT, Kransdorf MJ, Choi JJ (2001) Imaging of musculoskeletal fibromatosis. Radiographics 21:585–600PubMedCrossRef Robbin MR, Murphey MD, Temple HT, Kransdorf MJ, Choi JJ (2001) Imaging of musculoskeletal fibromatosis. Radiographics 21:585–600PubMedCrossRef
22.
go back to reference Gaskin CM, Helms CA (2004) Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol 182:733–739PubMedCrossRef Gaskin CM, Helms CA (2004) Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol 182:733–739PubMedCrossRef
23.
go back to reference Toirkens JDSA, Vanhoenacker FM, Van Dyck P, Gielen JL, Creytens D, Wouters K, Eiber M, Wörtler K, Parizel PM (2011) A comparison between histopathology and findings on magnetic resonance imaging of subcutaneous lipomatous soft-tissue tumors. Insights Imaging 2:599–607. doi:10.1007/s13244-011-0107-2PubMedPubMedCentralCrossRef Toirkens JDSA, Vanhoenacker FM, Van Dyck P, Gielen JL, Creytens D, Wouters K, Eiber M, Wörtler K, Parizel PM (2011) A comparison between histopathology and findings on magnetic resonance imaging of subcutaneous lipomatous soft-tissue tumors. Insights Imaging 2:599–607. doi:10.​1007/​s13244-011-0107-2PubMedPubMedCentralCrossRef
24.
25.
go back to reference Vanhoenacker FM, Camerlinck M, Somville J (2009) Imaging findings of a subcutaneous angioleiomyoma. JBR-BTR 92:80–82PubMed Vanhoenacker FM, Camerlinck M, Somville J (2009) Imaging findings of a subcutaneous angioleiomyoma. JBR-BTR 92:80–82PubMed
26.
go back to reference Van Hul E, Vanhoenacker F, Van Dyck P, De Schepper A, Parizel PM (2011) Pseudotumoural soft tissue lesions of the foot and ankle: a pictorial review. Insights Imaging 2:439–452. doi:10.1007/s13244-011-0087-2PubMedPubMedCentralCrossRef Van Hul E, Vanhoenacker F, Van Dyck P, De Schepper A, Parizel PM (2011) Pseudotumoural soft tissue lesions of the foot and ankle: a pictorial review. Insights Imaging 2:439–452. doi:10.1007/s13244-011-0087-2PubMedPubMedCentralCrossRef
28.
go back to reference Myhre-Jensen O (1981) A consecutive 7-year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas. Acta Orthop Scand 52:287–293PubMedCrossRef Myhre-Jensen O (1981) A consecutive 7-year series of 1331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas. Acta Orthop Scand 52:287–293PubMedCrossRef
29.
go back to reference Skov BG, Braendstrup O, Hirsch FR, Lauritzen AF, Nielsen HW, Skov T (1994) Are pathologists biased by clinical information?: A blinded cross-over study of the histopathological diagnosis of mesothelial tumours versus pulmonary adenocarcinoma. Lung Cancer 11:365–372PubMedCrossRef Skov BG, Braendstrup O, Hirsch FR, Lauritzen AF, Nielsen HW, Skov T (1994) Are pathologists biased by clinical information?: A blinded cross-over study of the histopathological diagnosis of mesothelial tumours versus pulmonary adenocarcinoma. Lung Cancer 11:365–372PubMedCrossRef
Metadata
Title
Grading and characterization of soft tissue tumors on magnetic resonance imaging: the value of an expert second opinion report
Authors
F. M. Vanhoenacker
K. Van Looveren
K. Trap
J. Desimpelaere
K. Wouters
P. Van Dyck
P. M. Parizel
A. M. De Schepper
Publication date
01-04-2012
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 2/2012
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-012-0151-6

Other articles of this Issue 2/2012

Insights into Imaging 2/2012 Go to the issue