eMedicine Specialties > Radiology > Musculoskeletal

Synovial Sarcoma: Follow-up

Author: Michael J Duh, MD, Associate Physician, Kaiser Permanente
Coauthor(s): Amilcare Gentili, MD, Clinical Professor of Radiology, University of California at San Diego; Consulting Staff, Department of Radiology, Thornton Hospital; Sulabha Masih, MD, Associate Professor of Diagnostic Radiology, University of California at Los Angeles; Consulting Staff, Department of Radiology, Section of Musculoskeletal Radiology, West Los Angeles Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Jul 13, 2007

Intervention

Diagnosis

Open biopsy is often difficult to perform, and the procedure is associated with an increased prevalence of complications such as anesthetic complications, unnecessary amputations, poor wound healing and breakdown, fracture, bleeding, and infection. Image-guided biopsy is now commonly performed for the initial histologic diagnosis of soft-tissue tumors16,17 because of the comparative ease, safety, and cost-effectiveness of this less-invasive procedure. Complication rates of percutaneous biopsies are as low as 1%, whereas those of open surgical biopsy are 2-20%.18

Reported accuracies of percutaneous techniques vary in the literature. One large study of CT-guided needle biopsy of musculoskeletal neoplasms revealed an accuracy of 93% for core-needle biopsy and 80% for fine-needle aspiration.

Because synovial sarcomas cannot be distinguished from other soft-tissue tumors, percutaneous biopsy techniques and considerations are no different from those for other soft-tissue masses. A potential but infrequent complication of biopsy includes intercompartmental contamination along the biopsy path with malignant tumor cells. Thus, the biopsy route should be discussed with the primary orthopedic surgeon to ensure that the needle tract can be easily incorporated in the eventual surgical resection.

Core biopsy can be easily performed by using a 14-gauge Tru-Cut needle (Travenol Laboratories Inc, Morton Grove, Ill) or similar device. Synovial sarcomas do not originate from bone; therefore, bone-cutting trephine-type needles are not needed. Fine-needle aspirations are performed with smaller 20- to 22-gauge needles.

In general, fine-needle aspiration is less accurate than other techniques for the diagnosis of soft-tissue tumors because of the lack of architectural information, smaller amounts of obtained tissue, and the need for specialized pathologic expertise in cytologic interpretation. Some authors report that fine-needle aspiration is adequate for the diagnosis of suspected metastatic disease, in which case the accuracy is high. Other authors advocate the use of both techniques in the percutaneous biopsy of soft-tissue tumors, stating that the information obtained is complementary and that many lesions are diagnosed by means of one and not the other. Accuracy rates for the diagnosis of lesions that are biopsied by both fine-needle aspiration and core biopsy are generally higher than those for either technique alone.

The choice of the imaging modality for biopsy guidance depends on the availability of the equipment, the expertise of the radiologist, and the characteristics of the lesion. CT scanning guidance is optimal for the biopsy of small lesions or those lesions that are near neurovascular bundles or other critical structures. Fluoroscopy is a real-time imaging modality that can be used for the biopsy of larger lesions that are easily seen on 2-dimensional radiographs. Ultrasonography can be used in select cases in which the lesion is more superficial and easily visible on real-time images.

The advantages of ultrasonography over CT scanning include the following: (1) continuous real-time visualization of the needle, (2) the ability to assess regions of viable tissue by using color-flow Doppler imaging, (3) the lack of ionizing radiation, (4) the availability of ultrasound scanners, (5) the reduced procedural time, and (6) overall cost-effectiveness. In some cases in which the tumor is not easily seen on CT scans or in which visualization of the tumor in several planes is desired, MRI-guided biopsy can be performed.

Treatment

Synovial sarcoma tumors are treated aggressively with limb-sparing therapy when possible. The recommended treatment is wide resection with negative margins, which often includes removing the surrounding muscle groups or total amputation. Resection is commonly followed by localized irradiation.

Multidrug adjuvant chemotherapy is currently recommended for systemic control of the cancer. However, although synovial sarcomas have been shown to be markedly chemosensitive, controversy exists over the actual survival benefit in patients.

 


More on Synovial Sarcoma

Overview: Synovial Sarcoma
Imaging: Synovial Sarcoma
Follow-up: Synovial Sarcoma
Multimedia: Synovial Sarcoma
References
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References

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Further Reading

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Keywords

synovioma, lower extremity carcinoma, synovial cancer, cancer of the lower extremities, musculoskeletal tumor, cancer of the upper extremities, t(X;18) translocation mutation, SYT gene, SSX1 gene, SSX2 gene

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Contributor Information and Disclosures

Author

Michael J Duh, MD, Associate Physician, Kaiser Permanente
Michael J Duh, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Amilcare Gentili, MD, Clinical Professor of Radiology, University of California at San Diego; Consulting Staff, Department of Radiology, Thornton Hospital
Amilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Sulabha Masih, MD, Associate Professor of Diagnostic Radiology, University of California at Los Angeles; Consulting Staff, Department of Radiology, Section of Musculoskeletal Radiology, West Los Angeles Veterans Affairs Medical Center
Sulabha Masih, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Medical Editor

David S Levey, MD, PhD, Orthopedic/Spine MRI TeleRadiologist, Radsource, LLC
David S Levey, MD, PhD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Murali Sundaram, MBBS, FRCR, FACR, Consulting Staff, Department of Diagnostic Radiology, The Cleveland Clinic Foundation
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

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