Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 14;16(1):123.
doi: 10.1186/s13244-025-02012-7.

Diagnostic work-up of lipomatous tumors: a decision-making analysis among European sarcoma centers

Ali Naimi  1   2 , Paul Martin Putora  3 , Christian Rothermundt  4 , Antonia Digklia  5 , Jose Manuel Asencio  6 , Sylvie Bonvalot  7 , Florian Bösch  8 , Anant Desai  9 , Amer James Durrani  10 , Haim Gutman  11 , Daphne Hompes  12 , Jens Jakob  13 , Wolfram Trudo Knoefel  14 , Elisabetta Pennacchioli  15 , Piotr Rutkowski  16 , Winan J van Houdt  17 , Barbara L van Leeuwen  18 , Stephan Waelti  19   20 , Tim Steffen Fischer  20   21 , Stefan Markart  19   20 , Simon Wildermuth  19 , Tobias Johannes Dietrich  19   20
Affiliations

Diagnostic work-up of lipomatous tumors: a decision-making analysis among European sarcoma centers

Ali Naimi et al. Insights Imaging. .

Abstract

Objectives: Lipomatous soft-tissue tumors present a diagnostic burden. The aim of this work was to compare standard operating procedures (SOPs) for the diagnostic management of lipomatous soft-tissue tumors among European academic centers.

Methods: Experts of the Soft Tissue and Bone Sarcoma Group of the European Organization for Research and Treatment of Cancer were asked for their SOPs in the diagnosis of adipocytic soft-tissue tumors in an otherwise healthy patient. The answers were converted to decision trees and subsequently compared using the objective consensus methodology. Mediastinal and retroperitoneal lipomatous tumors were excluded from the analysis.

Results: The highest consensus (93%) among fourteen institutions was noted for evaluation with core needle biopsy (CNB) as SOP for lipomatous tumors located deep in tissue exceeding 7 cm and tumor-associated symptoms. Evaluation of heterogeneous features on imaging by CNB usually showed a consensus rate of at least 75%. Consensus was less likely for lipomatous tumors without symptoms or heterogeneous features. In these settings, CNB and follow-up were almost equally recommended. For lipomatous tumors smaller than 3 cm, without growth or symptoms, no localization in the trunk, and homogeneous imaging features, a consensus rate of 71% was achieved for follow-up.

Conclusions: SOPs for diagnostic work-up of lipomatous tumors varied despite their geographical proximity. The highest consensus for biopsy was for deep large tumors with associated symptoms. For follow-up, consensus was shown for small homogenous tumors outside the trunk, without growth or symptoms. Consensus on resection involved homogeneous deeply located small tumors outside the trunk with growth and symptoms.

Critical relevance statement: This study identifies the decision-making criteria with the highest consensus rate among participating academic sarcoma centers in diagnosing lipomatous tumors: tumors located deep in the tissue, a tumor size exceeding 7 cm, and associated symptoms emerge as pivotal criteria.

Key points: Standard operating procedures for diagnostic work-up of lipomatous tumors among fourteen sarcoma centers were analyzed. Identified diagnostic criteria are: imaging features, size, growth, symptoms, superficial and trunk location. The highest consensus concerned recommending biopsies for deep tumors > 7 cm with associated symptoms.

Keywords: Adipocytic soft-tissue tumor; Decision-making; Diagnostic management; Lipoma; Liposarcoma.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable: The present study fulfills the conditions for not requiring official approval for operation according to the Swiss Federal Act on Research Involving Human Beings (Human Research Act). Consent for publication: Institutional review board approval and participants’ informed consent were not required because neither patients nor volunteers were directly included as participants. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Combination of decision criteria with a consensus rate of at least 75%. An arbitrary lower limit of 0 cm and an upper limit of 15 cm were applied for the size parameter, i.e., [0,5] means lesion size < 5 cm. The combination of decision criteria with a consensus of 93% is highlighted in bold borders. HF, heterogeneity features; CNB, core needle biopsy
Fig. 2
Fig. 2
Decision flow where the outcome follow-up reaches a consensus rate of at least 50%. An arbitrary lower limit of 0 cm and an upper limit of 15 cm were applied for the size parameter, i.e., [0,5] means lesion size < 5 cm. HF, heterogeneity features; FU, follow-up
See this image and copyright information in PMC

References

    1. Fritchie KJ, Goldblum JR, Mertens F (2020) Soft tissue and bone tumours. WHO classification of tumours, Vol. 3, 5th edn, International Agency for Research on Cancer, Lyon, France
    1. Mussi CE, Daolio P, Cimino M et al (2014) Atypical lipomatous tumors: should they be treated like other sarcoma or not? Surgical consideration from a bi-institutional experience. Ann Surg Oncol. 10.1245/s10434-014-3855-7 - PubMed
    1. Moulin B, Messiou C, Crombe A et al (2022) Diagnosis strategy of adipocytic soft-tissue tumors in adults: a consensus from European experts. Eur J Surg Oncol 48:518–525 - PubMed
    1. Craig WD, Fanburg-Smith JC, Henry LR et al (2009) From the archives of the AFIP: fat-containing lesions of the retroperitoneum: radiologic-pathologic correlation. Radiographics 29:261–290. 10.1148/rg.291085203 - PubMed
    1. Rizer M, Singer AD, Edgar M et al (2016) The histological variants of liposarcoma: predictive MRI findings with prognostic implications, management, follow-up, and differential diagnosis. Skelet Radiol 45:1193–1204 - PubMed

LinkOut - more resources