Keywords:
Tissue characterisation, Education and training, Education, Diagnostic procedure, Ultrasound, MR, Soft tissues / Skin, Musculoskeletal soft tissue
Authors:
N. Sivarasan, C. S. W. Tang, A. Zavareh; London/UK
DOI:
10.1594/essr2017/P-0172
Results
Of the 150 ultrasound studies querying lipoma,
125 identified a mass and 109 of these were defined as lipomas (N=109).
ATYPIA
|
Deep
|
>5cm
|
Ill-defined
|
Heterogenous
|
Hypervascular
|
n
|
5 (4.6%)
|
16 (6.8%)
|
7 (6.5%)
|
9 (8.3%)
|
1 (1%)
|
Not reported
|
34
|
4
|
13
|
28
|
27
|
Atypical Cases
|
N = 38
|
MRI advised
|
6
|
MRI performed within 6 months
|
4
|
The results demonstrate that of our sampled lipoma reports (n=109),
only 88 (81%) commented on all five criteria.
The most commonly omitted descriptors were depth,
heterogeneity and vascularity (see ‘Lipomas - Features Not Commented On’,
Fig. 2 ).
It is arguable that the person performing the study may have assessed all of the above in order to conclude that the mass is a lipoma,
however omitted this on the report.
The total number of ‘atypical’ lipomas was 38 (with only two studies having more than one atypical feature).
Of these 38 assessments,
only six were recommended for MRI investigation and of these,
four MRI scans were performed within six months.
One of these MRI scans identified a complex lipoma which was referred to a sarcoma unit; the remaining three were reported as ‘simple lipoma’.
It is worth noting that the ‘complex sarcoma’ was positive for four of the above criteria on ultrasound.
There was only one other lipoma presenting with more than one atypical feature,
and this report gave a diagnosis of ‘intramuscular lipoma.
Further evaluation is advised’.
This is suboptimal,
as there is no indication as to why further imaging is indicated and what type of imaging would be appropriate; this can be confusing for clinicians receiving the report.