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Soft-Tissue Lipomas: Accuracy of Sonography in Diagnosis with Pathologic Correlation¹

¹ From the Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, TC-2910G, Ann Arbor, MI 48109-0326 (P.I., J.A.J., R.C.C., S.V.P.); Department of Radiology, William Beaumont Hospital, Royal Oak, Mich (D.P.F.); Radiology Associates of Muncie, Ball Memorial Hospital, Muncie, Ind (L.O.D.S.); and Department of Radiology, Henry Ford Hospital, Detroit, Mich (M.T.v.H.). Received September 1, 2003; revision requested November 11; revision received March 26, 2004; accepted April 16. Address correspondence to J.A.J. (e-mail: jjacobsn@umich.edu).

PURPOSE: To retrospectively determine the accuracy of sonography in helping to distinguish soft-tissue lipomas from other soft-tissue masses by using histologic proof as the reference standard.

MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived. Thirty-nine patients who underwent sonographic evaluation of a soft-tissue mass followed by biopsy or resection were retrospectively evaluated. Two musculoskeletal radiologists (readers 1 and 2) reviewed the sonographic images, characterized the masses, and rated the level of confidence in the diagnosis of lipoma by using a five-point scale. A level of confidence was also rated for the prospective sonographic report, which was reviewed and designated as reader 3. Receiver operating characteristic (ROC) curves, including 95% confidence intervals, were generated, and the area under the ROC curve (A_z) was calculated for each reader. Sensitivity, specificity, and accuracy for each reader were calculated by using a confidence rating of 4 or 5 as positive for lipoma. Weighted analysis was also performed to assess for interobserver variability.

RESULTS: Histologic examination yielded 25 lipomas and 14 nonlipomas. The echogenicity of lipomas ranged from hypoechoic to hyperechoic relative to muscle, although most were isoechoic or hyperechoic. A_z values were 0.79 for reader 1, 0.56 for reader 2, and 0.77 for reader 3. There was no significant difference between the A_z for each reader and for chance. Interobserver agreement was fair, with a value of 0.35 among the three readers. Sensitivities were 52%, 40%, and 52%, and accuracies were 64%, 49%, and 64% for readers 1, 2, and 3, respectively.

CONCLUSION: Sonography demonstrates low accuracy in the diagnosis of soft-tissue lipomas.

© RSNA, 2004

Index terms: Lipoma and lipomatosis, 40.363 • Soft tissues, US, 40.1298 • Ultrasound (US), tissue characterization

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