title: Small, superficial, indeterminate soft-tissue lesions as suspected sarcomas: is primary excision biopsy suitable?
abstract: OBJECTIVE
  Suspected soft-tissue sarcomas are typically investigated using magnetic resonance imaging (MRI), with a view to planning image-guided core needle biopsy for confirmation of the histological diagnosis. Indeterminate superficial lesions may be small and therefore potentially difficult to biopsy safely, such lesions possibly being more amenable to primary excision biopsy. The aim of this study is to determine the suitability of this practice in the setting of a specialist sarcoma service.
  
  
  METHODS
  All patients referred over a 12-month period to the sarcoma service with a small (<3-cm), indeterminate, superficial soft-tissue mass according to MRI criteria, or a small lesion of the hand or foot deemed unsafe for percutaneous biopsy, and who underwent primary excision biopsy were included. The histology results were categorized into neoplastic and non-neoplastic lesions, and assessed for resection completeness.
  
  
  RESULTS
  Fifty-eight patients fulfilled the inclusion criteria from all patients referred to the sarcoma service in a 12-month period. Of these, 42 out of 58 (72.4%) had benign neoplasms, 4 out of 58 (6.9%) had malignant tumours, 2 out of 58 (3.4%) an intermediate grade lesion, while 10 out of 58 (17.2%) were non-neoplastic. All 4 malignant lesions were completely excised at the time of excision biopsy.
  
  
  CONCLUSIONS
  Primary excision biopsy of small, indeterminate soft-tissue masses within the setting of a specialist sarcoma service is a suitable management option. Only a small proportion of small superficial soft-tissue lesions with indeterminate MRI features are malignant tumours.
authors.affiliation: Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK. michael.khoo@rnoh.nhs.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Khoo
authors.affiliation: Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Pressney
authors.affiliation: Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: Rikin
authors.initials: R
authors.lastname: Hargunani
authors.affiliation: Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Saifuddin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology*; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: Benign soft-tissue tumour; Excision biopsy; Non-neoplastic soft-tissue mass; Soft-tissue sarcoma; Superficial