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Diagnostic work-up of lipomatous tumors: a decision-making analysis among European sarcoma centers

  • 1Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland. alinaimi2@gmail.com.
  • 2Faculty of Medicine, University of Zurich, Zurich, Switzerland. alinaimi2@gmail.com.
  • 3Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
  • 4Division of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
  • 5Sarcoma Center, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
  • 6General Surgery III Department and Liver Transplant Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
  • 7Department of Surgical Oncology, Institut Curie, Paris, France.
  • 8Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany.
  • 9Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
  • 10Department of Plastic Surgery, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK.
  • 11Surgical Oncology Unit, Department of Surgery, Herzliya Medical Center, Herzliya, Israel.
  • 12Department of Surgical Oncology, University Hospitals Gasthuisberg, Leuven, Belgium.
  • 13Sarcoma Unit, Department of Surgery, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
  • 14Department of General, Visceral and Pediatric Surgery, University Hospital, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
  • 15Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
  • 16Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
  • 17The Division of Surgical Oncology, Netherlands Cancer Institute, Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
  • 18Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
  • 19Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
  • 20Faculty of Medicine, University of Zurich, Zurich, Switzerland.
  • 21Radiology and Nuclear Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.
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June 14, 2025

Abstract

OBJECTIVES

Lipomatous soft-tissue tumors present a diagnostic burden. The aim of this work was to compare standard operating procedures (SOPs) for the diagnostic management of lipomatous soft-tissue tumors among European academic centers.

METHODS

Experts of the Soft Tissue and Bone Sarcoma Group of the European Organization for Research and Treatment of Cancer were asked for their SOPs in the diagnosis of adipocytic soft-tissue tumors in an otherwise healthy patient. The answers were converted to decision trees and subsequently compared using the objective consensus methodology. Mediastinal and retroperitoneal lipomatous tumors were excluded from the analysis.

RESULTS

The highest consensus (93%) among fourteen institutions was noted for evaluation with core needle biopsy (CNB) as SOP for lipomatous tumors located deep in tissue exceeding 7 cm and tumor-associated symptoms. Evaluation of heterogeneous features on imaging by CNB usually showed a consensus rate of at least 75%. Consensus was less likely for lipomatous tumors without symptoms or heterogeneous features. In these settings, CNB and follow-up were almost equally recommended. For lipomatous tumors smaller than 3 cm, without growth or symptoms, no localization in the trunk, and homogeneous imaging features, a consensus rate of 71% was achieved for follow-up.

CONCLUSIONS

SOPs for diagnostic work-up of lipomatous tumors varied despite their geographical proximity. The highest consensus for biopsy was for deep large tumors with associated symptoms. For follow-up, consensus was shown for small homogenous tumors outside the trunk, without growth or symptoms. Consensus on resection involved homogeneous deeply located small tumors outside the trunk with growth and symptoms.

CRITICAL RELEVANCE STATEMENT

This study identifies the decision-making criteria with the highest consensus rate among participating academic sarcoma centers in diagnosing lipomatous tumors: tumors located deep in the tissue, a tumor size exceeding 7 cm, and associated symptoms emerge as pivotal criteria.

KEY POINTS

Standard operating procedures for diagnostic work-up of lipomatous tumors among fourteen sarcoma centers were analyzed. Identified diagnostic criteria are: imaging features, size, growth, symptoms, superficial and trunk location. The highest consensus concerned recommending biopsies for deep tumors > 7 cm with associated symptoms.