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Can Abdominal Computed Tomography Imaging Help Accurately Identify a Dedifferentiated Component in a
Priya Bhosale1, Jieqi Wang, Datla Varma
1From the *Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX; †University of Kentucky College of Medicine, Lexington, KY; ‡Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX; §Department of Radiology, University of Pennsylvania, Philadelphia, PA; and Departments of ∥Surgical Oncology, and ¶Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Purpose:
To assess the ability of computed tomography (CT) to differentiate an atypical lipomatous tumor/well-differentiated liposarcoma (WDLPS) from a WDLPS with a dedifferentiated component (DDLPS) within it.
Materials And Methods:
Forty-nine untreated patients with abdominal atypical lipomatous tumors/well-differentiated liposarcomas who had undergone contrast-enhanced CT were identified using an institutional database. Three radiologists who were blinded to the pathology findings evaluated all the images independently to determine whether a dedifferentiated component was present within the WDLPS. The CT images were evaluated for fat content (≤25% or >25%); presence of ground-glass density, enhancing and/or necrotic nodules; presence of a capsule surrounding the mass; septations; and presence and pattern of calcifications. A multivariate logistic regression model with generalized estimating equations was used to correlate imaging features with pathology findings. Kappa statistics were calculated to assess agreement between the three radiologists.
Results:
On the basis of pathological findings, 12 patients had been diagnosed with DDLPS within a WDLPS and 37 had been diagnosed with WDLPS. The presence of an enhancing or a centrally necrotic nodule within the atypical lipomatous tumor was associated with dedifferentiated liposarcoma (P = 0.02 and P = 0.0003, respectively). The three readers showed almost perfect agreement in overall diagnosis (κ r = 0.83; 95% confidence interval, 0.67-0.99).
Conclusions:
An enhancing or centrally necrotic nodule may be indicative of a dedifferentiated component in well-differentiated liposarcoma. Ground-glass density nodules may not be indicative of dedifferentiation.
