What Do Ultrasound Images Find in Superficial Lumps and Bumps?

A conference consensus statement on ultrasound imaging of superficial soft-tissue masses aims to help radiologists and other clinicians differentiate between benign lumps and bumps, those that need further investigation, and those that need immediate management.

This paper will guide clinicians in their diagnosis and management and provide information about next steps after initial imaging with ultrasound, explained Nirvikar Dahiya, MD, associate professor of radiology, Mayo Clinic College of Medicine and Science, and radiology consultant at Mayo Clinic, Phoenix, Arizona. Dahiya is a member of the executive board of the Society of Radiologists in Ultrasound and one of the study authors.

“In many instances, ultrasound can confidently make the diagnosis of benign lesions,” said Dahiya in an interview with Medscape Medical News. “If it looks a bit worrisome on ultrasound, the question is then what to do next. Should there be a CT scan or an MRI or a biopsy? All of these questions made us think about doing this exercise and hopefully provide clinicians and imagers with a roadmap to appropriate management.”

The statement was published by the Society of Radiologists in Ultrasound in Radiology. The panel convened by the society was made up of specialists from radiology, orthopedic surgery, and pathology.

The paper outlines recommendations for superficial soft-tissue masses that are based on the current literature and common practice strategies. Specifically, it reviews commonly detected masses and provides management recommendations when the findings are typical or atypical.

For example, a lipoma is a benign soft-tissue mass that would not require any further investigations or management, but if the lipoma had a large amount of vascularity or other atypical features, that could signal an underlying cancer, Dahiya explained.

“If there is a lot of blood flow, then we would be worried because profuse blood flow in a lipoma means it could be malignant,” he said. “A malignant tumor requires really quick actions.”

A limitation of the statement is that it does not provide guidance on lesions that are not superficial, Dahiya said. “We did not address lesions that are deep to the fascia, or intramuscular lesions that may present as lumps and bumps, or even bony lesions that may present as a bump.”

The paper made recommendations for atypical findings in several of the soft-tissue masses to perform contrast-enhanced MRI as an additional imaging step.

A challenge in further diagnosis with atypical findings is that contrast-enhanced MRI may not be part of standard practice in imaging departments at many healthcare facilities compared with noncontrast MRI, Dahiya noted.

“The justification for contrast MRI is that once you found some atypical finding on ultrasound, you have already upped the ante in terms of diagnosis, and you might as well direct that person to a place that offers contrast-enhanced MRI,” he said.

The consensus paper reinforces the need for appropriate imaging, said Christopher Fung, MD, assistant clinical professor, Department of Radiology and Diagnostic Imaging, University of Alberta, and diagnostic imaging site lead at the University of Alberta Hospital in Edmonton, Alberta, Canada.

“We see a lot of these [superficial soft-tissue masses] that frankly don’t need any other imaging,” said Fung, who is not an author of the paper. “I think this paper is trying to address that.”

In addition, the consensus statement would act as a decision tool for clinicians who are unclear about what to do next when faced with atypical findings, Fung pointed out.

“The general radiologist may not know if what they are looking at is lymphoma or whether it is an epidermal inclusion cyst,” Fung said. “It may be hard to look up the classic findings and remember what you learned in residency. This is a great reference paper. There was a void or vacuum in terms of a simple, straightforward document.”

Dr Dahiya had no relevant disclosures. Dr Fung is a Partner Radiologist with Medical Imaging Consultants and stakeholder with Mikata Health.

Radiology. 2022;000:1-11. Full text

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