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Diagnostics of soft tissue sarcoma of the abdomen and pelvis

Clinical examination

Specific or nonspecific symptoms in addition to a thorough clinical examination may alert the physician to the possible diagnosis of a soft tissue sarcoma. The physician may use one or more radiological modalities in order to help establish the correct diagnosis.

Computed Tomography (CT)

CT is the preferred general screening tool for abdominal and retroperitoneal tumors. It has as the main advantages short scan times, limited motion artifacts and reproducible results. The introduction of helical CT and especially multi-slice technique has improved anatomical detail and the quality of multi-planar reconstructions. CT of the abdomen and pelvis can be complemented with a CT of the chest in order to fully evaluate the possibility of metastatic disease.

Magnetic resonance imaging (MRI)

Though CT is the preferred imaging tool for the abdomen and pelvis, MRI scan is a superb adjunct to the evaluation of tumors in the pelvis. While motion artifacts significantly reduce image quality of the abdomen and to certain extent of the retroperitoneum, MRI of the pelvis can greatly aid in defining the extent of disease and in the establishment of the correct diagnosis in the pelvis.

Ultrasound (US)

Abdominal ultrasounds are often performed for initial screening and can lead to the detection of a tumor and the decision of further work-up with CT. Their quality is highly dependent on the examiners experience and they are not reproducible.

X-rays

A chest x-ray is often used as the initial screening test for possible disease extention in the chest.

Endoscopy

Gastroscopy is usually performed to evaluate tumors in the upper gastrointestinal tract, including esophagus, stomach and duodenum. It can be supplemented with endoscopic US and possibly endoscopic fine-needle biopsy.

Referral to a Sarcoma Center

Clinical and radiological findings suspect for a soft tissue sarcoma (CT) form the background for further referral to a sarcoma center. The patient with a tumor suspicious of a sarcoma should be referred to a sarcoma center without previous biopsy or operation. The attempt at biopsy or tumor removal can lead to spreading of tumor cells and drastically reduce the possibility for successful curative treatment.

At a sarcoma center, clinical information and images are assessed by a multidisciplinary team, and further work-up, the necessity of a biopsy and treatment are determined.

Typical image diagnostic findings

CT of retroperitoneal sarcoma. Click to enlarge image. CT of GIST in stomach. Click to enlarge image. MRI of leiomyosarcoma in the uterus. Click to enlarge image.

Biopsy

Cytology by fine-needle aspiration or biopsi-guided by ultrasound or CT scan is the method of choice for obtaining tissue and establishing the correct histological diagnosis. 

A fine-needle aspiration or biopsy is deemed necessary in the following cases:

  • For a tumor with uncertain nature where the diagnosis is decisive to determine whether the patient will be operated or whether the patient will be treated with chemotherapy or radiotherapy.
  • For a tumor with uncertain nature where the operative treatment extend is dependant on the benign or malignant nature of the tumor.

Retroperitoneal, intra-abdominal, gynecological or abdominal wall tumors are often removed without previous biopsy in order to avoid spreading of tumor cells.

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