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Published on: August 16, 2020
[Bone and soft tissue tumours in children : Proposal for a rational diagnostic approach]
1Klinik für Diagnostische und Interventionelle Radiologie, Kinderradiologie und Neuroradiologie, Artemed Klinikum Freiburg, Sautierstr. 1, 79104, Freiburg, Deutschland. markus.uhl@rkk-klinikum.de.
Insights
This study proposes an algorithm to help radiologists diagnose pediatric bone and soft tissue tumors, potentially reducing the need for biopsies in many cases.
Area of Science:
- Pediatric Radiology
- Oncology
- Diagnostic Imaging
Background:
- Bone and soft tissue tumors in children are often incidental findings.
- Nonspecialist radiologists may lack experience in differentiating benign from malignant pediatric tumors.
- Accurate diagnosis is crucial for appropriate management and avoiding unnecessary procedures.
Purpose of the Study:
- To present an algorithm for determining the malignancy of bone and soft tissue tumors in children.
- To improve diagnostic accuracy and reduce the need for invasive procedures like biopsies.
- To provide a standardized approach for evaluating pediatric skeletal and soft tissue lesions.
Main Methods:
- Utilized sonography, computed tomography (CT), and magnetic resonance imaging (MRI) for tumor evaluation.
- Developed algorithms based on European professional society guidelines, adapted for pediatric patients.
- Proposed a diagnostic pathway prioritizing imaging techniques and guiding biopsy decisions.
Main Results:
- The proposed algorithms aim to avoid unnecessary biopsies in the majority of pediatric cases.
- Aggressive bone lesions and unclear soft tissue tumors are identified for biopsy.
- The algorithms are adapted from established European guidelines for pediatric use.
Conclusions:
- Sonography is the primary tool for soft tissue tumor evaluation, followed by MRI if needed.
- Biopsies are recommended for unclear or potentially malignant cases.
- Biopsy confirmation should occur at a pediatric oncology center for optimal care.
Clinical/Methodological Issue:
Bone and soft tissue tumours are often incidental findings in children. Because they are usually benign tumours, nonspecialised radiologists generally have little experience in the diagnosis and differentiation from malignant tumours. Various imaging techniques are used in the diagnosis of skeletal tumours.
Standard Radiological Methods:
Imaging techniques used to evaluate bone and soft tissue tumours include sonography, computed tomography (CT) and magnetic resonance imaging (MRI).
Methodological Innovations:
An algorithm to determine malignancy of bone and soft tissue tumours in children is proposed.
Performance:
By using the presented algorithms, further diagnostic procedures such as biopsies can be avoided in the majority of children with bone and soft tissue tumours. Aggressive bone lesions and unclear soft tissue tumours are guided to biopsy to confirm diagnosis.
Achievements:
The algorithms presented are based on the proposals of European professional societies and have been adapted by the authors for use in children and adolescents.
Practical Recommendations:
In the clarification of soft tissue tumours, sonography is the first diagnostic tool; depending on the sonographic findings, MRI is the technique for further clarification. Biopsy confirmation of the diagnosis in unclear cases or in cases of probable malignancy should be carried out in a paediatric oncology centre.
