What do ultrasound images find in superficial lumps and bumps?

A conference consensus statement on ultrasound imaging of superficial soft tissue masses is intended to help radiologists and other clinicians differentiate between benign lumps and lumps, those that require further investigation, and those that require immediate management.

This article will guide clinicians in their diagnosis and management and provide information on next steps after initial ultrasound imaging, explained Nirvikar Dahiya, MD, associate professor of radiology, Mayo Clinic College of Medicine and Science, and radiology consultant at Mayo Clinic, Phoenix, Arizona. Dahiya is a board member of the Society of Radiologists in Ultrasound and one of the study’s authors.

“In many cases, ultrasound can confidently diagnose benign lesions,” Dahiya said in an interview with Medscape Medical News. “If it looks a bit concerning on the ultrasound, then the question is what to do next. Should there be a CT scan or an MRI or a biopsy? All of these questions got us thinking about doing this exercise and hopefully -the, will provide clinicians and imagers with a roadmap for proper management.

The statement was released by the Society of Radiologists in Ultrasound in Radiology. The panel convened by the company was made up of specialists in radiology, orthopedic surgery and pathology.

The document presents recommendations for superficial soft tissue masses that are based on current literature and common practice strategies. Specifically, it examines commonly detected masses and provides management recommendations when findings are typical or atypical.

For example, a lipoma is a benign soft tissue mass that would not require further investigation or management, but if the lipoma had a large amount of vascularity or other atypical features, it could signal underlying cancer, a explained Dahiya.

“If there’s a lot of blood flow, we’d be concerned because heavy blood flow to a lipoma means it could be malignant,” he said. “A malignant tumor requires very quick actions.”

A limitation of the statement is that it does not provide guidance on lesions that are not superficial, Dahiya said. “We haven’t addressed deep fascia damage, or intramuscular damage that can present as lumps and bumps, or even bone damage that can present as a lump.”

The article made recommendations for atypical findings in several of the soft tissue masses to perform contrast-enhanced MRI as an additional imaging step.

A challenge in later diagnosis with atypical findings is that contrast-enhanced MRI may not be standard practice in imaging departments at many healthcare facilities compared to non-contrast MRI, Dahiya noted. .

“The rationale for contrast MRI is that once you’ve found an atypical finding on ultrasound, you’ve already upped the ante in terms of diagnosis, and you might as well refer that person to a place that offers contrast-enhanced MRI,” he said.

The consensus document reinforces the need for appropriate imaging, said Christopher Fung, MD, assistant clinical professor, Department of Radiology and Diagnostic Imaging, University of Alberta, and diagnostic imaging site lead at the University of Alberta Hospital in Edmonton, Alberta, Canada.

“We see a lot [superficial soft-tissue masses] which frankly don’t need any other imagery,” said Fung, who is not the author of the article. “I think this article tries to solve this problem.

Additionally, the consensus statement would act as a decision tool for clinicians unsure of what to do next when faced with atypical findings, Fung pointed out.

“The general radiologist may not know if what they’re looking at is lymphoma or if it’s an epidermal inclusion cyst,” Fung said. “It can be difficult to research the classic results and remember what you learned in residency. It’s a great reference material. There was a gap or a void in terms of a simple, straightforward document.”

Dr. Dahiya had no relevant disclosure. Dr. Fung is a Radiologist partner of Medical Imaging Consultants and stakeholder of Mikata Health.

Radiology. 2022;000:1-11. Full Text

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