{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:41:16Z","timestamp":1787064076955,"version":"build-2736575974"},"reference-count":22,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: This study aimed to develop a reliable scoring system combining clinical and radiological parameters to distinguish atypical lipomatous tumours (ALTs) from lipomas, improving diagnostic accuracy and reducing expensive molecular pathology testing. Methods: A retrospective analysis of 188 patients who underwent surgery for lipomatous tumours was conducted. Patient data, including medical history, pathology, and MRI imaging results, were reviewed. Four predictive models were developed using various clinical and imaging parameters, including age, tumour size, location, and MRI characteristics (homogeneity, contrast enhancement). Statistical analysis, including ROC curve analysis and logistic regression, was performed to assess the accuracy of these models. Results: The highest predictive accuracy was achieved with Model 1, which included seven parameters, yielding an AUC of 0.952. This model achieved a sensitivity of 96.4% and a negative predictive value (NPV) of 97.2%. Reducing the number of parameters lowered the accuracy, with contrast enhancement playing a significant role in Model 1. A risk calculator based on the optimal model was developed, offering an effective tool for clinical use that can be provided. Notably, 21 out of 37 ALTs lacked atypia and would have been missed without molecular testing. Conclusions: The developed scoring system, based on clinical and imaging parameters, accurately distinguishes ALTs from lipomas, offering a practical alternative to molecular pathology testing. This multi-parameter approach significantly improves diagnostic reliability, reducing the risk of misclassification and false negatives, while also potentially lowering healthcare costs.<\/jats:p>","DOI":"10.3390\/diagnostics15121538","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T05:52:47Z","timestamp":1750139567000},"page":"1538","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Atypical Lipomatous Tumours vs. Lipomas: A Multimodal Diagnostic Approach"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4828-1812","authenticated-orcid":false,"given":"Wolfram","family":"Weschenfelder","sequence":"first","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2018-2187","authenticated-orcid":false,"given":"Katharina Lucia","family":"Koeglmeier","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2903-391X","authenticated-orcid":false,"given":"Friederike","family":"Weschenfelder","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Spiegel","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1978-6627","authenticated-orcid":false,"given":"Amer","family":"Malouhi","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"Gassler","sequence":"additional","affiliation":[{"name":"Institute of Forensic Medicine, Pathology Section, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunther Olaf","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"103162","DOI":"10.1016\/j.otsr.2021.103162","article-title":"Management of adipose tumors in the limbs","volume":"108","author":"Crenn","year":"2022","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1016\/j.annonc.2021.07.006","article-title":"Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"32","author":"Gronchi","year":"2021","journal-title":"Ann. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.suc.2022.04.006","article-title":"Lipoma and Its Doppelganger: The Atypical Lipomatous Tumor\/Well-Differentiated Liposarcoma","volume":"102","author":"Yee","year":"2022","journal-title":"Surg. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1007\/s11547-023-01657-y","article-title":"MRI radiomics-based machine learning for classification of deep-seated lipoma and atypical lipomatous tumor of the extremities","volume":"128","author":"Gitto","year":"2023","journal-title":"Radiol. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.tjem.2016.09.008","article-title":"A systematic and technical guide on how to reduce a shoulder dislocation","volume":"16","author":"Alkaduhimi","year":"2016","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1097\/PAS.0000000000000713","article-title":"MDM2 and CDK4 Immunohistochemistry: Should It Be Used in Problematic Differentiated Lipomatous Tumors?: A New Perspective","volume":"40","author":"Clay","year":"2016","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"812089","DOI":"10.1155\/2015\/812089","article-title":"Fluorescence In Situ Hybridization for MDM2 Amplification as a Routine Ancillary Diagnostic Tool for Suspected Well-Differentiated and Dedifferentiated Liposarcomas: Experience at a Tertiary Center","volume":"2015","author":"Thway","year":"2015","journal-title":"Sarcoma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1097\/PAS.0000000000000468","article-title":"MDM2 Amplification in Problematic Lipomatous Tumors: Analysis of FISH Testing Criteria","volume":"39","author":"Clay","year":"2015","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1097\/PAS.0b013e3181e92d0b","article-title":"Molecular testing for lipomatous tumors: Critical analysis and test recommendations based on the analysis of 405 extremity-based tumors","volume":"34","author":"Zhang","year":"2010","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1007\/s00256-020-03372-5","article-title":"Qualitative evaluation of MRI features of lipoma and atypical lipomatous tumor: Results from a multicenter study","volume":"49","author":"Nardo","year":"2020","journal-title":"Skelet. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Nagano, S., Yokouchi, M., Setoguchi, T., Ishidou, Y., Sasaki, H., Shimada, H., and Komiya, S. (2015). Differentiation of lipoma and atypical lipomatous tumor by a scoring system: Implication of increased vascularity on pathogenesis of liposarcoma. BMC Musculoskelet. Disord., 16.","DOI":"10.1186\/s12891-015-0491-8"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1055\/a-2189-5412","article-title":"Contrast-enhanced ultrasound reveals perfusion differences between benign lipoma and semi-malignant atypical lipomatous tumors: A prospective clinical study","volume":"45","author":"Mick","year":"2024","journal-title":"Ultraschall Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/PAI.0000000000001098","article-title":"Silver In Situ Hybridization for the Rapid Assessment of MDM2 Amplification in Soft Tissue and Bone Tumors. Validation Based on an Audit of 192 Consecutive Cases Evaluated by Silver In Situ Hybridization and Fluorescence In Situ Hybridization","volume":"31","author":"Farshid","year":"2023","journal-title":"Appl. Immunohistochem. Mol. Morphol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1002\/jcla.21794","article-title":"Comparison of Chromogenic In Situ Hybridization and Fluorescence In Situ Hybridization for the Evaluation of MDM2 Amplification in Adipocytic Tumors","volume":"29","author":"Mardekian","year":"2015","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.jmoldx.2020.11.011","article-title":"A Rapid and Cost-Effective Gene Expression Assay for the Diagnosis of Well-Differentiated and Dedifferentiated Liposarcomas","volume":"23","author":"Wang","year":"2021","journal-title":"J. Mol. Diagn."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1002\/pst.2099","article-title":"Joint hypothesis testing of the area under the receiver operating characteristic curve and the Youden index","volume":"20","author":"Yin","year":"2021","journal-title":"Pharm. Stat."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ballhause, T.M., Korthaus, A., Jahnke, M., Frosch, K.H., Yamamura, J., Dust, T., Schlickewei, C.W., and Priemel, M.H. (2022). Lipomatous Tumors: A Comparison of MRI-Reported Diagnosis with Histological Diagnosis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12051281"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s00256-012-1517-z","article-title":"MRI characteristics of lipoma and atypical lipomatous tumor\/well-differentiated liposarcoma: Retrospective comparison with histology and MDM2 gene amplification","volume":"42","author":"Brisson","year":"2013","journal-title":"Skelet. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.asjsur.2018.12.012","article-title":"Developing a clinical scoring system to differentiate deep-seated atypical lipomatous tumor from lipoma of soft tissue","volume":"42","author":"Cheng","year":"2019","journal-title":"Asian J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/s11604-022-01278-x","article-title":"Discrimination of lipoma from atypical lipomatous tumor\/well-differentiated liposarcoma using magnetic resonance imaging radiomics combined with machine learning","volume":"40","author":"Cay","year":"2022","journal-title":"Jpn. J. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.diii.2020.01.015","article-title":"Quantitative signal intensity ratios to distinguish between subfascial lipoma and atypical lipomatous tumor\/well-differentiated liposarcoma using short-tau inversion recovery (STIR) MRI","volume":"101","author":"Donners","year":"2020","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s00292-009-1257-6","article-title":"Lipoma and atypical lipomatous tumor within the same neoplasia: Evidence for a continuous transition","volume":"31","author":"Kuhnen","year":"2010","journal-title":"Pathologe"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1538\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:53:25Z","timestamp":1760032405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1538"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":22,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["diagnostics15121538"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15121538","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,17]]}}}