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LEVEL OF EVIDENCE: 4 SUMMARY Objective. Soft Tissue Sarcoma (STS) is a rare form of cancer which includes a variety of malignant connective tissue neoplasms with high morbidity and mortality. Amongst these, undifferentiated pleomorphic sarcoma – accounting for up to 20% of all sarcoma – lacks a specifically identified line of cellular differentiation. Magnetic Resonance imaging (MR) have been used for local staging of STS, determining tumour extent, tumour characteristics, and neurovascular bundle infiltration. In addition to histologic evaluation following percutaneous biopsy, MR can possibly be used as a non-invasive investigation to determine tumour grade as it has been successfully used as a surrogate marker for other malignant tumours, for example: brain tumours. We evaluated similar MRI utility for undifferentiated pleomorphic sarcoma to assess necrosis as a possible predictor of histological grading. Methods. We evaluated 47 cases of histologically proven undifferentiated pleomorphic sarcoma. We hypothesized that there was a direct correlation between the degree of tumour necrosis on MR and histologic grade. Two experienced consultant musculoskeletal radiologists blinded to histological grade of tumour evaluated MR images retrospectively. The extent of tumour necrosis was categorised as < 25% – MR grade I, 26-50% – MR grade II, 51-75% – MR grade III and > 76% – MR grade IV. Final pathologic grading using Fédération Nationale des Centres de Lutte le Cancer (FNCLCC) classification were obtained for all patients which divide tumour grades into low (grade I) and high (grade II and III) category and correlated with MRI results. Results. 17 (36.1%) patients with MR Necrosis grade I, 8 (17.02%) patients with MR necrosis grade II and 10 (21.27%) patients with MR necrosis grade III, were highgrade STS (grade III significantly higher than grade II) histologically. Whereas, out of 12 (25.53%) patients with MR necrosis grade IV demonstrating more than 75% tumour necrosis, 1 (2.12%) patient was low-grade (FNCLCC grade I) and rest were high-grade STS including 1 (2.12%) patient of grade II and 10 (21.27%) patients of grade III. Conclusions. We were unable to establish positive or negative correlation between the degree of necrosis on MR and histological grade of STS on this cohort study.

Exploring Correlation between Extent of Tumour Necrosis on MRI And Histological Grade of Soft Tissue Sarcoma. An Initial Experience