The role of computed tomography in the management of soft tissue sarcomas

Seventy-seven patients with soft tissue sarcoma underwent computed tomography (CT) between 1977 and 1981. The results have been analysed to determine the characteristics of these tumours on CT, the accuracy of CT in predicting resectability and in the detection of distant metastases, and the influence of CT findings on patient management. The majority of tumours appeared as masses which were well-defined, either by surrounding soft tissue planes or because the tumour had a significantly different attenuation value to the surrounding tissues. No correlation was found between the characteristics on CT and the tumour histology. A prediction of operability based on the CT appearances was compared with the surgical findings in 24 patients. This prediction was correct in 22 patients (92%) and further useful surgical information was provided in 11 patients (46%). A comparison of the CT findings with those of chest radiography, including whole lung tomography, showed that CT demonstrated a significantly larger number of pulmonary metastases. CT was also useful in revealing unsuspected local recurrences in four of 18 patients although one false positive diagnosis was made. Overall, the information provided by CT altered the clinical management in 18 patients (23%); the most important change was that surgery was avoided. Computed tomography should be regarded as the investigation of choice for the assessment of the primary or locally recurrent tumour and the detection of "occult" pulmonary metastases.