Introduction: In patients with soft tissue tumors (STT), treatment planning depends on tumor entity.
Core needle biopsy (CNB) is the diagnostic standard. Contrast-enhanced ultrasonography
(CEUS) has provided promising results but is still not widely used in the evaluation
of STT, especially when located in the retroperitoneum. The purpose of this study
was to evaluate the role of CEUS in diagnosing STT.
Methods: This is a retrospective study of 69 Patients (35 male, 34 female) subjected to CEUS-guided
CNB, treated from Dec 2021 to July 2024 at the Sarcoma Center of the University Medical
Center Goettingen. US and CEUS were performed with the Logiq S8 XDClear (GE, USA)
and using sulfur hexafluoride microbubbles (SonoVue, Bracco, Italy) as contrast medium.
Adequate probes with sufficient and probable diagnosis were analysed for accuracy
in differentiating between malignant and benign, furthermore however diagnosing subtype
and grading.
The masses biopsied were located in the abdomen and retroperitoneum (n=15), trunk
(including shoulder, neck, hip, glutes) (n=22), upper (n=3) and lower extremities
(n=26) as well as groin (n=3).
Results: The patients’ age ranged from 22 to 86 years at time of biopsy. Out of 69 STS, adequate
samples were retrieved through CEUS-guided biopsy in 64 (28 benign, 36 malignant)
cases (92,75%). 46 cases could be compared histopathologically to resected specimen.
After adequate CEUS-CNB-sampling and comparison to resected specimen (42 cases=91,3%),
our results showed no false positives or negatives regarding differentiation between
malignant and benign masses; sensitivity and specificity were 100%. PPV as well as
NPV were also 100%. Considering histopathological subtypes, 41/42 yielded correct
histopathological subtype (97,6%). In malignant masses, 18/22 diagnosis were concordant
in initial and definitive grading (81%). No peri- or postinterventional complications
occurred.
Conclusion: CEUS-guided CNB is safe and has proven to be a promising method in guiding biopticsampling
of STT, directing the needle to the most significant areas of the tumor. The need
for re-biopsy is low and can safely be conducted, if necessary, while concordance
in histopathological diagnosis of biopsy and resection sample is extremely high. This
allows for precise diagnosis and optimised neoadjuvant treatment for patients.
