Distinction between benign and malignant soft tissue tumors based on an ultrasonographic evaluation of vascularity and elasticity

The initial diagnostic distinction between benign and malignant soft tissue tumors is critical for decisions regarding the appropriate course of treatment. The current study aimed to evaluate the vascularity and elasticity of soft tissue tumors by superb microvascular imaging and shear wave elastography using ultrasonography (US), to determine their usefulness in distinguishing malignant soft tissue tumors, and to further establish the diagnostic accuracy and usefulness of a scoring system (SS) based on these evaluations. The present study used 167 lesions of soft tissue tumors examined by US prior to biopsy, surgery and pathological tissue diagnosis. The vascularity index (VI) and the maximal shear velocity (MSV), as indices of vascularity and elasticity respectively, were evaluated using US. The tumor size and depth were also evaluated via magnetic resonance imaging (MRI). Based on the odds ratio of these parameters determined by multivariate logistic regression analysis, an original SS was established to identify the malignancy of soft tissue tumors. VI and MSV exhibited significantly high values for malignant tumors. Tumor size was also significantly larger for malignant than benign tumors. The areas under the curves (AUCs) of the receiver operating characteristic analysis for VI, MSV and tumor size were 0.75, 0.84 and 0.69, respectively, indicating that these methods were effective for the diagnosis of malignancy. An original SS consisting of VI, MSV and tumor size, excluding tumor depth, was established, and revealed an AUC value of 0.90, with 93.6% sensitivity and 79.2% specificity for malignancy distinction. US evaluation of vascularity and elasticity was an effective technique to distinguish malignant soft tissue tumors, and the current SS based on US evaluations including tumor size via MRI demonstrated a high diagnostic accuracy for malignant soft tissue tumors.