Which imaging modalities are recommended for the initial assessment of suspected sarcomas in primary care?

For the initial assessment of suspected sarcomas in primary care, ultrasound scanning is the recommended first-line imaging modality, especially when a soft tissue sarcoma is suspected or when clinical concern persists despite uncertain ultrasound findings. This approach facilitates early identification and guides urgent referral decisions to specialist services via a suspected cancer pathway NICE NG234,NICE NG12.

In cases where bone sarcoma is suspected, plain X-ray imaging may be used initially in children and young people to identify possible bone lesions, prompting very urgent specialist referral if suspicious features are present NICE NG12. However, plain X-rays are not recommended for diagnosing spinal metastases or sarcomas involving the spine NICE NG234.

Magnetic resonance imaging (MRI) is the preferred advanced imaging modality for further characterisation and staging of sarcomas once initial suspicion is raised, as it provides superior soft tissue contrast and detailed anatomical information critical for treatment planning NICE NG234. If MRI is contraindicated, computed tomography (CT) can be considered as an alternative, although it is less sensitive for soft tissue evaluation NICE NG234.

Recent literature supports the use of ultrasound as a valuable non-invasive tool in the early detection of soft tissue sarcomas, highlighting its role in primary care to triage patients effectively and expedite specialist assessment Algarin et al. 2024. Additionally, advanced imaging techniques such as MRI remain central to comprehensive sarcoma diagnostics, consistent with guideline recommendations Vieth 2019.