Dr Randall on the Potential Role of Ultrasound in Soft Tissue Sarcoma Surveillance

“Ultrasound could play a larger role in STS surveillance, either as a compliment or a substitute to MRI, but we need further, high-quality, prospective data to inform this pursuit further.”

R. Lor Randall, MD, FACS, the David Linn Endowed Chair for Orthopedic Surgery, the chair of the Department of Orthopedic Surgery, and a professor at the University of California Davis Comprehensive Cancer Center, discussed the potential benefits of incorporating ultrasound into the soft tissue sarcoma (STS) diagnostic and surveillance paradigm.

Randall was a corresponding author on a scoping review comparing imaging protocols for the surveillance of local recurrence in patients following surgical resection of extremity STS. The scoping review showed that ultrasound and MRI exhibit comparable diagnostic accuracy, he began. The review, which included 8 studies and followed PRISMA-ScR guidelines, revealed that ultrasound had similar overall accuracy compared with MRI. Across the studies included in the review that directly compared the modalities with each other, no statistically significant differences in diagnostic performance were observed.

Randall further emphasized that ultrasound offers substantial cost savings and may increase accessibility for patients requiring long-term surveillance. This finding is crucial because the goal of the scoping review was to address the considerable knowledge gap in developing surveillance strategies that achieve optimal clinical outcomes, taking resource use and cost-effectiveness into account, he emphasized

Given the comparable performance and significant cost differences between these modalities, Randall suggested that the fields should consider the potential adoption of hybrid strategies that combine the strengths of both ultrasound and MRI to optimize surveillance. Emerging evidence supports the use of these hybrid surveillance protocols, he added.

Despite these encouraging findings, Randall pinpointed critical weaknesses in the existing literature on this topic. The most significant weakness is the lack of multicenter, randomized controlled trials comparing the effect of ultrasound-based, MRI-based, and combined surveillance strategies on survival outcomes, he said. Randall noted the intent to address this knowledge gap by pitching this type of study to cooperative groups, recognizing that running a non-interventional study would pose its own set of challenges but would shed robust light on the issue. Furthermore, Randall highlighted that although limited cost analyses have been performed, the literature entirely lacks quality-of-life (QOL) data. The absence of QOL metrics presents an opportunity for formal cost analysis studies that integrate patient-reported outcomes to enhance clinical decision-making, he reported. In conclusion, Randall stated that ultrasound could play a larger role in STS surveillance, whether as a complement to or substitute for MRI, but further, high-quality, prospective data are essential to inform this pursuit and validate these initial findings.