THE VALUE OF ROUTINE POSTOPERATIVE MRI SCANNING IN DETECTING LOCAL RECURRENCE OF TRUNK AND EXTREMITY SOFT TISSUE SARCOMA

Abstract

Introduction and aims: Despite advances in local therapy, there is an ongoing risk of local recurrence after treatment for soft tissue sarcoma. Early detection of local recurrence with MRI scanning may improve outcomes for patients. The purpose of this retrospective study was to evaluate the usefulness of routine postoperative MRI scans in diagnosing clinically occult local recurrence after surgery for trunk and extremity soft tissue sarcomas.

Material and Methods: We reviewed the clinical and radiology records of all patients who underwent surgery for trunk or extremity soft tissue sarcoma in our service with the potential for 3 years of follow up. We looked at the number of postoperative MRI scans performed, the indications for the scans (routine or clinical suspicion of recurrence) and the scan results.

Results: Between 1998 and 2003, 151 patients met the inclusion criteria. The mean age was 59 (17 – 94) years. The diagnosis was liposarcoma in 37%, malignant fibrous histiocytoma in 17%, and leiomyosarcoma in 15%. Reflecting differences in practice between consultants, 79 patients had routine postoperative MRI scans, 8 patients had MRI scans following clinical suspicion of a local recurrence, and 64 patients did not have a postoperative MRI scan. Of 79 patients undergoing a total of 354 routine postoperative scans, 2 had detection of a local recurrence not suspected clinically. This represents a cost of £55,224 per recurrence detected. Of the 8 patients who underwent MRI scanning for a clinical suspicion of local recurrence, 4 had a local recurrence confirmed on scanning.

Conclusions: Most local recurrences are detected clinically. The cost of detecting local recurrence of a trunk or extremity soft tissue sarcoma by MRI scanning is high. The benefit of earlier detection over clinical examination is not known.