MRI surveillance for postsurgical musculoskeletal soft-tissue sarcomas improves patient outcomes: AJR

Canada: MRI-based surveillance following surgical treatment of musculoskeletal soft-tissue sarcomas (STS) is useful for detecting clinically occult local recurrences (LRs) and could improve outcomes, an accepted manuscript published in ARRS’ American Journal of Roentgenology has shown. 

The study showed that when MRI-based surveillance of musculoskeletal STSs was used at a high intensity, 53% of local recurrences were discovered with MRI.

“When used at a high intensity, MRI-based surveillance can detect many clinically occult LRs, although the studies are small, occasionally conflicting, and often of poor quality,” wrote corresponding author Natalia Gorelik, MD, from the department of diagnostic radiology at McGill University Health Center in Montreal, Quebec, Canada. “A survival benefit could be associated with imaging use, but further research is needed to evaluate the causality of any observed survival differences.”

In this AJR systematic review and meta-analysis, Gorelik et al. systematically searched multiple electronic databases through November 2022 for controlled trials and cohort studies on the usefulness of MRI-based surveillance for musculoskeletal STS. A total of 4,821 unique titles and abstracts were identified. After screening for eligibility and snowball sampling, 19 studies were included; all were retrospective cohorts.

Using an adapted Newcastle-Ottawa scale for assessing bias risk, random effects meta-analyses of the proportion of LRs discovered by MRI, as opposed to clinically, were conducted. The association of low- versus high-intensity surveillance-high intensity is defined as at least one local surveillance imaging examination for low-risk tumors and at least three for high-risk tumors during the first two posttreatment years-with; the proportion of LR detected on MRI was assessed with a chi-square test of subgroup differences.

Ultimately, when MRI-based surveillance of musculoskeletal STSs was used at a high intensity, 53% (95% CI, 36–71%) of LRs were discovered with MRI. Four studies reported trends toward better survival for imaging-detected LRs or with more frequent imaging use.

Reference:

Natalia Gorelik, Samir Paruthikunnan, Aashna Uppal, Ann-Margret Ervin, Agnihotram V. Ramanakumar, Andrea Quaiattini, James M. Brophy, and Soterios Gyftopoulos, American Journal of Roentgenology doi/10.2214/AJR.22.28865