title: Image intensive soft tissue sarcoma surveillance uncovers pathology earlier than patient complaints but with frequent initially indeterminate lesions.
abstract: BACKGROUND
  Post-treatment surveillance follow-up soft-tissue sarcomas is controversial. Protocols are highly variable. This study retrospectively evaluates an image intense protocol to assess benefits of identifying true pathology compared to incidental findings.
  
  
  METHODS
  A retrospective chart review was conducted on a single orthopedic oncologist's soft tissue sarcoma patients under a consistent protocol (TAD). Study population included patients who underwent resection of non-metastatic soft tissue sarcoma (AJCC stages I-III) and either died within surveillance period or completed 5 years of follow-up.
  
  
  RESULTS
  Thirty-nine patients met the strict study criteria. 24/39 (61.5%) patients were identified to have a local recurrence (6), chest metastasis (6), isolated distant recurrence (9), or new primary tumor (3). Of those 24 patients with true pathology, 13 (54%) or 33% (13/39) of all patients potentially benefited from discovery via imaging before patient complaint. Chest CT was the first to reveal all lung metastases. For balance, 32/39 (82%) patients had at least 1 initially "indeterminate" lesion on imaging. Of those, 91% (29/32)-74% of all patients (29/39)-proved to be inconsequential by final follow up.
  
  
  CONCLUSIONS
  Of the true pathology identified, over half were not evident on clinical presentation, emphasizing the importance of a routine surveillance. However, an image intense surveillance program has a high rate of initially indeterminate findings. J. Surg. Oncol. 2016;113:818-822. © 2016 Wiley Periodicals, Inc.
authors.affiliation: SUNY Upstate Department of Orthopedics, Upstate Bone and Joint Center, East Syracuse, New York.
authors.forename: Kyle
authors.initials: K
authors.lastname: Richardson
authors.affiliation: SUNY Upstate Department of Orthopedics, Upstate Bone and Joint Center, East Syracuse, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Potter
authors.affiliation: SUNY Upstate Department of Orthopedics, Upstate Bone and Joint Center, East Syracuse, New York.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Damron
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CT scan; MRI; local recurrence; metastases; soft-tissue sarcoma; surveillance