CORR Insights®: Does Advanced Imaging Have a Role in Detecting Local Recurrence of Soft-tissue Sarcoma?

Orthopaedic oncologists have focused much of their sarcoma research interests over the past decade on molecular diagnostics, improved levels of evidence, and surveillance. Detecting early disease progression, local and distant, may reduce mortality in certain patients, making surveillance (periodic assessment of a patient for recurrence after treatment) an important aspect of management. Sarcomas are rare, heterogeneous in behavior, and capricious in their response to treatment. The most advantageous modality and frequency of surveillance, especially regarding local recurrence, remain elusive. Authors have suggested that imaging is variable in its predictability for detecting local recurrence [1, 7, 8]. Recent sarcoma studies have concentrated on the timing of surveillance compared with the specific modality. At least one of the authors of England et al.’s study [5], who is well-versed on this topic, has coauthored frequency-based peerreviewed publications on sarcoma surveillance (skeletal sarcoma [2] and an excellent review article published this year [3]). In this issue of Clinical Orthopaedics and Related Research, England et al. [5] reported on the detection of local recurrence in patients with soft-tissue sarcomas. Most tumors were in the extremities, high-grade, and deep. The retrospective study was conducted at a tertiary medical center that was experienced in treating sarcomas. The average detected size of a local recurrence reported in England et al.’s study [5] was approximately 4 cm, the size of a golf ball, and these recurrences are often palpable. Other variables such as depth, age, radiation, BMI, or use of a flap did not affect the detection of local recurrence. The importance of this study is that a conventional or “oldfashioned” history and physical examination may be better at detecting local recurrence than advanced imaging techniques such as CT, MRI, or positron emission tomography.