Focus on the tumour periphery in MRI evaluation of soft tissue sarcoma: infiltrative growth signifies poor prognosis

Abstract

Purpose. Infiltrative microscopical peripheral growth of soft tissue sarcomas (STS) has been shown to be of prognostic importance and preoperative risk stratification could individualize neoadjuvant treatment. Patients and methods. We assessed peripheral tumour growth pattern on preoperative MRI from 78 STS. The findings were correlated to histopathology and to outcome. Results. The MRI-based peripheral tumour growth pattern was classified as pushing in 34 tumours, focally infiltrative in 25, and diffusely infiltrative in 19. All tumours with diffuse infiltration on MRI also showed microscopical infiltration, whereas MRI failed to identify infiltration in two-thirds of the microscopically infiltrative tumours. Diffusely infiltrative growth on MRI gave a 2.5 times increased risk of metastases (P = .01) and a 3.7 times higher risk of local recurrence (P = .02). Discussion. Based on this observation we suggest that MRI evaluation of STS should focus on the peripheral tumour growth pattern since it adds prognostic information of value for decisions on neoadjuvant therapies.

Figure 1

Examples of MRI scans and whole-tumour sections stained with haematoxylin and erythrosine from 2 different leiomyosarcomas; (a) a subcutaneous tumour of the thigh with a pushing growth pattern on MRI, but microscopic infiltration on histopathology, (b) an intramuscular tumour of the thigh with focally infiltrative growth pattern on both MRI and histopathology.

Figure 2

Kaplan-Meier survival curves in relation to infiltrative growth identified on MRI (P = .02).