It is the consensus recommendation that if a mass is less than 5cm, superficial, and not by critical structures (axilla, groin, popliteal fossa, over a subcutaneous bone) then a principled excisional biopsy without ultrasound evaluation is reasonable. Should a patient not desire removal but reassurance, ultrasound may be able to confirm cystic nature and allow observation in the absence of growth (Nagano 2015). Wagner et al (2013) noted high accuracy for lipomas with 96.9% specificity for superficial masses. In cases where the size or depth of the lesion cannot be determined by physical examination, ultrasound can provide anatomic location to guide further evaluation and treatment. It is the consensus recommendation that if a mass is greater than 5cm, or deep, or by critical structures then an ultrasound evaluation is unlikely to obviate the need for advanced imaging and may delay treatment or provide false reassurance. In particular circumstances, such as vascular malformations (Furta 2017), ultrasound can aid in making a diagnosis and avoiding a biopsy, but in this setting ultrasound could be ordered if desired by a referral center. Moderate and high-quality studies are evaluating means of distinguishing benign versus malignant soft tissue masses by ultrasound (eg., Pass 2017, Chen 2009 a, Chen 2009 b). However, it is the opinion of the work group that there is not yet sufficient sensitivity for malignancy or specificity for benignity for ultrasound evaluations to obviate the need for further advanced imaging for large or deep or precariously located lesions (Nagano 2015). In these suspicious circumstances, an ultrasound should not be required prior to obtaining an MRI. In other clinical situations, such as evaluating a possible soft tissue sarcoma recurrence, ultrasound may be an effective means of surveillance and directing a biopsy (Arya 2000). We did not find any literature discussing use of ultrasound in bone lesions and suggest that our recommendations apply only to soft tissue tumors.
- Arya,S.; Nagarkatti,D.G.; Dudhat,S.B.; Nadkarni,K.S.; Joshi,M.S.; Shinde,S.R. Soft tissue sarcomas: ultrasonographic evaluation of local recurrences
- Belli,P.; Costantini,M.; Mirk,P.; Maresca,G.; Priolo,F.; Marano,P. Role of color Doppler sonography in the assessment of musculoskeletal soft tissue masses
- Wagner,J.M.; Lee,K.S.; Rosas,H.; Kliewer,M.A. Accuracy of sonographic diagnosis of superficial masses