How good is CT for grading of soft tissue tumor?

Usefulness of computed tomography findings for predicting soft tissue sarcoma grades

Jeongyun Jeong, Myounghun Kim, Jongwon Koo, Yewon Joo, Heejung Yu, Minjoo Kim, Jungmin Kwak, Jaehwan Kim, Kidong Eom

Background
Soft tissue sarcomas (STSs) are malignant mesenchymal tumors in dogs that vary in behavior and prognosis based on histological grade. Accurate preoperative prediction of STS grades can guide treatment decisions, particularly for planning surgical margins. This study aimed to evaluate whether computed tomography (CT) findings can differentiate between low-grade (Grade 1), intermediate-grade (Grade 2), and high-grade (Grade 3) STSs in dogs.

Methods
A retrospective observational study included 30 dogs diagnosed with histologically graded STSs between 2020 and 2024 from three veterinary hospitals in South Korea. Inclusion criteria required a histological diagnosis of STS and pre- and post-contrast CT imaging. CT findings, including qualitative features (e.g., tumor margins, vascular patterns, cystic regions) and quantitative features (e.g., size, attenuation), were evaluated. Statistical analyses assessed the associations between CT findings and tumor grades.

Results
Demographics:
-Tumor grades: 12 Grade 1, 10 Grade 2, 8 Grade 3.
-Median age: 9–12 years; no breed or sex predisposition.

Key CT Findings:
-Tumor size significantly increased with grade; Grade 3 tumors were larger (median size: 7.8 cm) than Grade 1 tumors (4.3 cm; P = .01).
-Dysmorphic vessels were more common in Grade 3 tumors compared to Grade 1 (P = .004).
-Peritumoral fat stranding and metastatic lymphadenopathy were more prevalent in Grade 3 tumors, though not all comparisons reached statistical significance.
-Intratumoral cystic lesions were more frequently observed in Grade 2 and 3 tumors (>50% of tumor volume) but did not significantly differ between grades (P = .059).

Diagnostic Utility:
-A tumor size cutoff of ≥5.7 cm predicted Grade 3 STSs with 75% sensitivity and 77% specificity.
-Dysmorphic vessels and lymphadenopathy were strong predictors of high-grade tumors.

Limitations
Small sample size may have limited the statistical power of some findings.
Retrospective design and lack of standardized CT protocols across institutions could introduce variability.
Histological grading inconsistencies may arise from preoperative biopsy samples compared to surgical specimens.

Conclusions
CT imaging can aid in predicting high-grade (Grade 3) STSs through features such as larger tumor size, dysmorphic vessels, and lymphadenopathy. This information supports preoperative planning by helping identify more aggressive tumors, potentially improving outcomes through tailored interventions. Further studies with larger populations and standardized imaging protocols are recommended.

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