Soft tissue sarcomas constitute less than 1% of all malignancies. [1] Soft tissue masses have a benign to malignant ratio of over 100:1 [2,3] meaning that a large number of lesions which are ultimately benign will undergo imaging investigation and biopsy. Elastography uses external compression to determine tissue strain and lesion stiffness.[4] The more recent development of acoustic radiation force impulse (ARFI) imaging does not require operator external compression and so should give less variability. Soft tissues are transiently deformed using acoustic radiation and the...

Patient Population The institutional ethics committee approved the study protocol and all patients underwent informed consent. Consecutive patients were prospectively referred from the specialist sarcoma service over a 9 month period for soft tissue biopsy of an extremity soft tissue mass with no clinical exclusion criteria. B-Mode ultrasound imaging All B-mode imaging was performed by one of three experienced consultant musculoskeletal radiologists (15, 6 and 4 years experience) using ultrasound (Siemens Acuson S3000, Erlangen, Germany) and a linear array transducer (9-4 MHz). B-mode ultrasound findings...

The original recruitment target was n=135; however, due to limited equipment availability, n=114 patients were recruited. Of these 114 patients, 9 did not have shearwave measurements available and were excluded from analysis. In the remaining 105 patients, in 6 cases no biopsy was performed because of patient choice (n=5) or technically difficult biopsy (n=1). All had benign imaging appearances and the lesions were assumed to be benign for the purposes of analysis as at follow-up imaging (12 months) all lesions have remained unchanged (n=5) or...

Conventional imaging cannot always differentiate between malignant and benign lesions meaning that biopsy is required to establish a diagnosis and guide management. [21,22] The consensus B-mode ultrasound scoring demonstrated sensitivity and specificity of 76.9% and 78.8%, confirming that it is not sufficiently accurate to be used alone in providing this differentiation, although this was under study conditions where scorers were blinded to the history and any other imaging performed. In this study 9 masses scored as benign or indeterminate benign on B-mode imaging alone were...

1. Kransdorf MJ, Murphey MD. Imaging of soft tissue tumors. Philadelphia: Lippincott Williams & Wilkins; 2006. ISBN 0-7817-4771-6 2. Clark MA, Fisher C, Judson I, et al. Soft-tissue sarcomas in adults. N Engl J Med 2005;353:701e11. 3. Clasby R, Tilling K, Smith MA, et al. Variable management of soft tissue sarcoma: regional audit with implications for specialist care. Br J Surg 1997;84:1692e6 4. Yoon JH, Kim MH, Kim EK, et al. Interobserver variability of ultrasound elastography: how it affects the diagnosis of breast lesions. Am...