Abstract
Detection of local recurrence after sarcoma resection can be impaired by metal implants locally, or by the patient ‘s general condition. Metal implants cause severe distortion and scattering of either MRI or CT data acquisition. Therefore the detection of local recurrences in proximity of heavy metal implants such as prostheses or osteosynthesis material can be difficult. Patient related conditions, e.g. renal insufficiency, allergy, claustrophobia, may completely prohibit the use of contrast media or even a scan itself.
Ultrasound provides several advantages, and can be used for different indications in sarcoma patients. Patient related conditions prove no obstacle for this technique. Currently our indications are local follow-up after soft-tissue sarcoma resection and evaluation of regional lymph nodes, detection of local recurrence of bone sarcoma in proximity of metal implants, and amputation stump evaluation.
We describe a patient study population of 103 patients. Seventeen had only diagnostic and staging ultrasound, four had an evaluation of their amputation stump, 24 were followed after resection of a soft-tissue sarcoma, and 58 were followed by this method after sarcoma resection and implantation of metallic implants. Evaluation modalities are described according to the indications.
Results: We have detected nine local recurrences, and four patients with suspect lymph nodes had a biopsy of which half showed malignant tumour cells. Infection and inflammation around metallic implants can be evaluated, the technique also allowing placement of drains in infected seromas in irradiated regions. It should be emphasised that reliable results can only be achieved if a baseline ultrasound is performed, followed by subsequent studies at regular intervals.
Correspondence should be addressed to Professor Stefan Bielack, Olgahospital, Klinikum Stuttgart, Bismarkstrasse 8, D-70176 Stuttgart, Germany. Email: s.bielack@klinikum_stuttgart.de
