{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:50:32Z","timestamp":1781769032468,"version":"3.54.5"},"reference-count":30,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,24]],"date-time":"2024-11-24T00:00:00Z","timestamp":1732406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Catholic Medical Center Research Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/cancers16233935","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T08:38:24Z","timestamp":1732523904000},"page":"3935","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Are Imaging Evaluations of Soft-Tissue Masses Before Referral to a Specialized Center Being Performed Properly? A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1348-2187","authenticated-orcid":false,"given":"Min Wook","family":"Joo","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"},{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan Jin","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3646-749X","authenticated-orcid":false,"given":"Yong-Suk","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoon Joo","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas Matthew","family":"Bernthal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6296-5559","authenticated-orcid":false,"given":"Seul Ki","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunho","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Department of Internal Medicine, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3234-8541","authenticated-orcid":false,"given":"Joo Hwan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0139-5003","authenticated-orcid":false,"given":"Sung Hwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang-Guk","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.4055\/jkoa.2015.50.4.269","article-title":"Diagnoses and Approaches of Soft Tissue Tumors for Orthopaedic Non-Oncologists","volume":"50","author":"Kang","year":"2015","journal-title":"J. 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