Background/Objectives: Since the initial approach towards the clinical presentation of soft-tissue masses is challenging for frontline physicians, some countries use clinical practice guidelines. Proper imaging work-up is crucial to differentiate between soft-tissue tumors. Recently, ultrasonography and magnetic resonance imaging (MRI) have been widely used. But there is some controversy about whether pre-referral evaluations are being conducted properly. Thus, this study aims to assess whether the ultrasonography investigation of soft-tissue masses prior to referral to the musculoskeletal tumor center is being performed adequately in terms of indications, diagnostic accuracy, and referral interval, and to evaluate whether the pre-referral MRI for soft-tissue masses is being conducted reasonably concerning indications, imaging protocol, reporting, diagnostic accuracy, and cost-effectiveness. Methods: The study protocol was registered. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We performed a database search of the MEDLINE, Embase, and Cochrane Library. Then, two authors reviewed the studies, and the third author resolved any disagreement between them. A total of nine studies were included. The Risk Of Bias In Non-Randomized Studies-of Interventions was applied. Relevant data were extracted by two authors. Results: This review showed that the way that the imaging investigations are performed in non-specialized centers before referral was generally considered inappropriate. Conclusions: Frontline physicians should regard the alarm symptom as an indication for advanced imaging evaluation. Education and certification may be required for ultrasonography. MRI should be performed and interpreted in a specialized center or by a specialist with relevant expertise. Guidance may help reduce inappropriate imaging.
背景/目的：由于软组织肿块的临床表现对一线医生构成初步诊断挑战，部分国家已采用临床实践指南。规范的影像学检查对鉴别软组织肿瘤至关重要。近年来，超声与磁共振成像已得到广泛应用，但关于转诊前评估是否规范实施仍存在争议。本研究旨在评估转诊至肌肉骨骼肿瘤中心前，针对软组织肿块的超声检查在适应症、诊断准确性和转诊间隔方面是否充分执行，并评价转诊前磁共振成像在适应症、成像方案、报告质量、诊断准确性与成本效益方面的合理性。方法：研究方案已完成注册。我们遵循系统综述与荟萃分析优先报告条目清单，检索了MEDLINE、Embase及Cochrane图书馆数据库。由两位研究者独立筛选文献，第三方仲裁分歧，最终纳入九项研究。采用非随机干预研究偏倚风险评估工具，由两位研究者提取相关数据。结果：本综述表明，非专科中心在转诊前实施的影像学检查方式普遍存在不规范现象。结论：一线医生应将警示症状视为进行高级影像学评估的指征。超声检查可能需要实施规范化培训与资质认证。磁共振成像应在专科中心或由具备专业资质的专家执行与解读。临床指南可能有助于减少不规范影像学检查。
肿瘤(癌症)患者之家