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62. Kongress der Deutschen Gesellschaft für Handchirurgie

Deutsche Gesellschaft für Handchirurgie

06. bis 08. Oktober 2022, Garmisch-Partenkirchen

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Tumors of unknown origin found in the hand and digits: evaluation of preoperative imaging – can ultrasound replace MRI?

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  • corresponding author presenting/speaker Tina Rauchenwald - Universitätsklinik für Plastische-, Rekonstruktive- und Ästhetische Chirurgie Innsbruck, Innsbruck, Austria
  • Hannes Gruber - Universitätsklinik für Radiologie Innsbruck, Innsbruck, Austria
  • Leonhard Gruber - Universitätsklinik für Radiologie Innsbruck, Innsbruck, Austria
  • Turkhan Mehdiyev - Universitätsklinik für Plastische-, Rekonstruktive- und Ästhetische Chirurgie Innsbruck, Innsbruck, Austria
  • Caroline Bauer - Universitätsklinik für Plastische-, Rekonstruktive- und Ästhetische Chirurgie Innsbruck, Innsbruck, Austria
  • Yannick Scharll - Universitätsklinik für Radiologie Innsbruck, Innsbruck, Austria
  • Gerhard Pierer - Universitätsklinik für Plastische-, Rekonstruktive- und Ästhetische Chirurgie Innsbruck, Innsbruck, Austria
  • Alexander Loizides - Universitätsklinik für Radiologie Innsbruck, Innsbruck, Austria
  • Robert Zimmermann - Universitätsklinik für Plastische-, Rekonstruktive- und Ästhetische Chirurgie Innsbruck, Innsbruck, Austria

Deutsche Gesellschaft für Handchirurgie. 62. Kongress der Deutschen Gesellschaft für Handchirurgie. Garmisch-Partenkirchen, 06.-08.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. Doc22dgh03

doi: 10.3205/22dgh03, urn:nbn:de:0183-22dgh030

Published: October 6, 2022

© 2022 Rauchenwald et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives: The objective of this study is to determine the role of preoperative ultrasound diagnosis of soft tissue tumors of the hand and digits. Furthermore, this study investigates the accuracy of ultrasound in comparison to magnetic resonance imaging (MRI).

Method: A retrospective data analysis of patients of all ages presenting with soft tissue tumors of the hand or digits between January 1st, 2013, and December 31st, 2020, was conducted. All included patients underwent preoperative ultrasound evaluation followed by surgical tumor excision. Demographic data, radiological findings and histopathological diagnosis were documented. Tumors were classified according to the 2020 WHO classification of tumors of soft tissue. Diagnostic properties of ultrasound and MRI included sensitivity, specificity, and correct classification rates (CCR). Intertest agreement between ultrasound and MRI was calculated as kappa.

Results and Conclusion: Upon data analysis, 194 patients with an average age of 48.6 (±19.2) years were included. Sex distribution was equal. Most lesions occurred between the age of 40 and 60. Histopathologically, the majority (91%, n=177) of lesions were benign, while 8% (n=15) were intermediate and 1% (n=2) were malignant. Main differentiators between benign and intermediate/malignant differentiation were size (p<0.001), palmar localization (p=0.015), distal finger localization (p=0.022), and ultrasound border definition (p=0.022). Single MRI features did not allow differentiation of subtypes. Ultrasound exhibited a sensitivity of 77.1%, a specificity of 47.1% and a correct classification rate (CCR) of 74.5%, while MRI exhibited a sensitivity of 45.7%, a specificity of 83.3% and a CCR of 51.2%. Overall agreement between ultrasound and MRI was substantial at a weighted kappa of 0.616 (95% CI 0.343 to 0.815).

In conclusion, ultrasound presented superior to MRI in the preoperative work-up of soft tissue tumors of the hand and digits regarding the correct classification of tumor differentiation. We propose US as the first-line diagnostic tool in small soft tissue tumors of unknown origin in the hand and digits.