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Optimal surgical margin for infiltrative soft tissue sarcomas: Assessing the efficacy of excising beyond the infiltration
Author(s) -
Iwata Shintaro,
Araki Akinobu,
Funatsu Hiroyuki,
Yonemoto Tsukasa,
Kamoda Hiroto,
Itami Makiko,
Ishii Takeshi
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25165
Subject(s) - medicine , infiltration (hvac) , soft tissue , magnetic resonance imaging , soft tissue sarcoma , nuclear medicine , surgical margin , radiology , pathology , surgery , resection , physics , thermodynamics
Background Tumor infiltration in soft tissue sarcoma (STS) is known to correlate with an inadequate surgical margin and poor local control. This study aims to determine whether the radiological infiltration (R‐inf) in STS cor relates with histological infiltration (H‐inf) and to devise methods to determine a resection margin for infiltrative STS. Methods We reviewed the medical records of 145 patients with high‐grade STS. We measured the R‐inf on short‐T1 inversion recovery or gadolinium‐enhanced fat‐suppressed (GdFS) magnetic resonance imaging. In addition, we assessed H‐inf as the infiltrative growth of atypical tumor cells. The local control rate (LCR) was assessed using the Kaplan‐Meier method. Results A statistically significant positive correlation was found between H‐inf and R‐inf ( P < 0.0001). The R‐inf obtained from the GdFS images exhibited a stronger correlation with H‐inf than that obtained from the short‐T1 inversion recovery images. Univariate and multivariate analyses revealed that a positive H‐inf significantly correlated with a poor LCR. Moreover, the contaminated margins, which included intrainfiltration margins, significantly correlated with a poor LCR compared with the wide margins. Conclusions R‐inf as assessed by the GdFS images significantly correlates with H‐inf, suggesting that we should exercise the infiltrative STS beyond their R‐infs detected by the GdFS images.