Utility of chest computed tomography for staging in patients with T1 extremity soft tissue sarcomas

BACKGROUND. National Cancer Center Network (NCCN) and Society of Surgical O ncology (SSO) practice guidelines recommend chest computed tomography (CT) as part of the staging evaluation of patients with extremity soft tissue sa rcoma (STS). In the current study, the authors evaluated the use and yield of chest roentgenography (CXR) and selective chest CT to screen for pulmona ry metastases in patients with T1 STS. METHODS. The utility of these staging studies was evaluated retrospectively in a cohort of 125 consecutive patients who presented to a tertiary care c ancer center with TI primary (nonrecurrent) extremity STS. Two diagnostic s trategies (CXR alone vs. CXR plus chest CT) were evaluated using an increme ntal cost-effectiveness ratio. RESULTS. The majority of tumors (70%) were high grade. The median sarcoma s ize was 3.0 cm; 64 of the tumors (51%) were located deep to the investing f ascia of the extremity. All patients underwent staging CXR; 1 CXR (< 1%) wa s suspicious for metastatic disease. Fifty-one patients (41%) also underwen t chest CT; 1 chest CT, performed in the patient with a suspicious CXR, rev ealed metastatic disease. With a median follow-up of 76 months, 19 patients (15%) developed metachronous pulmonary metastases. The relatively low yiel d resulted in an incremental cost-effectiveness ratio of $59,772 per case o f synchronous pulmonary metastasis detected by CXR plus chest CT. CONCLUSIONS. Less than 1% of patients with TI primary extremity STS were fo und to have pulmonary metastases that were detectable using a staging algor ithm that employs routine CXR with the selective use of chest CT. The findi ngs of the current study do not support current NCCN or SSO practice guidel ines for patients with high-grade TI STS. (C) 2001 American Cancer Society.