Childhood Soft Tissue Sarcoma Diagnosis

Soft tissue sarcomas are complex and can grow in many different areas of the body. This means they are often difficult to diagnose. However, an accurate diagnosis is crucial to successful treatment. An incorrect diagnosis may lead to unnecessary procedures or affect future treatment options and outcomes.

In many cases, a biopsy is needed to confirm the diagnosis. If possible, this biopsy should be performed at the cancer center where your child will be treated. It’s important to go to a center that sees a large number of pediatric sarcoma patients and has a specialized team, including pathologists, radiologists, surgeons and oncologists.

Soft tissue sarcoma diagnostic tests

If your child has symptoms that may indicate a soft tissue sarcoma, the doctor will perform a thorough physical exam and take a detailed medical history, including questions about your child’s health and your family’s medical history. One or more of the following tests may be used to confirm a diagnosis and determine whether the cancer has spread. These tests also help guide treatment planning.

Biopsy

The only way to be certain your child has a soft tissue sarcoma is through a biopsy. This involves removing a small sample of tissue from the tumor to examine under a microscope. Surrounding tissue and lymph nodes may also be biopsied. Imaging tests often help guide the biopsy and determine the tumor’s location and extent.

The doctor will select the biopsy type based on tumor size, location and other factors:

• Fine needle aspiration (FNA): This method is not commonly used for sarcoma because it may not provide enough information. A very thin needle is inserted into the tumor, and suction is used to collect cells. CT scans may be used to guide the needle. If the results suggest sarcoma, a larger tissue sample will usually be taken.
• Core needle biopsy: A larger needle removes a cylindrical tissue sample for more detailed examination. This is more commonly used for the diagnosis of sarcoma.
• Incisional biopsy: A small incision is made, and a portion of the tumor is removed for testing.
• Excisional biopsy: The entire tumor is surgically removed. This approach is usually limited to tumors smaller than 2 centimeters and is generally avoided for suspected sarcoma because tumor removal should be performed as a carefully planned cancer surgery rather than as a simple biopsy.

Biopsies are usually outpatient procedures, but depending on the child’s age and tumor location, sedation or anesthesia may be required. Families can expect minor soreness or bruising at the biopsy site for a few days.

Imaging tests

Imaging is used to locate the tumor precisely, assess its size and relationship to the surrounding soft tissue structures, and see whether it has spread to other parts of the body. Imaging tests may include:

• MRI scans: Create detailed cross-sectional images of the tumor and surrounding structures. They highlight differences in soft tissue, which helps distinguish the tumor from normal tissue.
• PET scans: Detect areas of high metabolic activity that may indicate cancer spread.
• Chest X-rays: Check for abnormalities in the lungs.
• CT or CAT scans: Provide detailed images of the lungs when used to examine the chest. When used on the arms or legs, they create cross-sectional images of the tumor and surrounding structures.
• Ultrasound: May be used to evaluate superficial or smaller tumors.

Each imaging test provides different information. Radiologists, oncologists and surgeons review the images together to ensure an accurate diagnosis and optimal treatment plan.

Getting a second opinion at children’s cancer hospital

The pediatric cancer experts at Children’s Cancer Hospital welcome the opportunity to provide second opinions for soft tissue sarcoma.

If you would like to get a second opinion at Children’s Cancer Hospital, call 877-632-6789 to make an appointment or request an appointment online.