Novel Scoring System Predicts the Malignancy of Soft-Tissue Tumors

A recently developed reporting system may significantly improve the diagnosis of soft tissue tumors, offering a standardized way to assess risk and guide clinical management.

Known as the Soft-Tissue Tumor Reporting and Data System (ST-RADS), this MRI-based framework was designed to help providers determine whether a soft tissue lesion requires biopsy, surgical excision, or monitoring. While histopathology remains the definitive diagnostic tool, imaging is often the first step in evaluating tumor characteristics. In some cases, ST-RADS could reduce the need for invasive procedures or provide an alternative when such procedures are not feasible.

“Biopsy or surgical excision may not always be feasible due to factors such as lesion location, associated morbidity, and cost,” said Avneesh Chhabra, MD, with the Department of Radiology at UT Southwestern Medical Center in Dallas. “Imaging helps distinguish true neoplasms from tumor-like mimics such as hematoma, abscess, and ganglia, etc., by assessing key features including clinical findings and margin definition, internal signal heterogeneity, enhancement pattern, and lesion size. MRI is especially valuable for delineating tumor extent and its relationship to surrounding anatomical structures, which is essential for surgical planning and determining resectability.”

Currently, radiologists correctly predict soft tissue tumor malignancy using imaging alone in only about 60% of cases. ST-RADS was developed to improve on this rate by introducing a structured scoring system.

To test its effectiveness, researchers applied the system to MRI studies from more than 200 patients at a tertiary care center. They compared patient demographics, imaging features, biopsy findings, and clinical outcomes alongside the ST-RADS scores assigned by readers. These scores were then measured against standard descriptive reports to evaluate diagnostic accuracy.

The results were striking. ST-RADS achieved an overall accuracy of 99.2%, outperforming traditional descriptive reports, which reached 92.8%. ST-RADS scores aligned with biopsy results in nearly 98% of cases, while descriptive reports matched histopathology only 83% of the time. Readers also correctly classified all benign tumors when using ST-RADS guidelines.

These findings suggest the system has meaningful potential in clinical settings, particularly in improving diagnostic confidence and reducing unnecessary interventions.

“Prospective application of the ST-RADS scoring system demonstrated significantly superior accuracy compared to traditional descriptive methods,” the authors concluded. “These results advocate for broader implementation of ST-RADS in clinical practice as a standardized method for classifying musculoskeletal soft tissue tumors, standardized management recommendations, and longitudinal data collection for tracking patient outcomes.”