Optimal surveillance for detecting sarcoma lung metastasis – A systematic review

Introduction: Accurate diagnosis of lung metastasis for patients with soft tissue sarcoma (STS) can impact overall survival, but there is considerable variability in imaging utilized to detect metastasis. Chest x-ray (CXR) or computer tomography (CT) scan of the chest are the most common studies in current practice. Methods: A systematic literature search was performed. Databases were searched from inception to January 3, 2024. Articles were reviewed to determine if CXR or CT chest was associated with improved overall or recurrence-free survival in patients with STS. Articles were also reviewed for data on cost-effectiveness of CXR versus CT chest. The quality of evidence was assessed by the Critical Appraisal Skills Programme. Results: 259 abstracts were screened, and twenty-seven studies were selected for full-text review. Nine studies met all inclusion criteria. Seven studies included data on survival or recurrence rates and four included data on the cost of imaging modality. The seven studies all had conflicting results on the impact of CXR versus chest CT on survival and recurrence. The four studies that looked at cost found that CXR was more cost-effective, but in certain patients, screening with chest CT could be cost-effective. Conclusion: The literature defining the optimal surveillance method for lung metastases for patients with STS is limited. Most of the studies had a low quality of evidence due to study design and significant risk of bias. Randomized controlled trials are needed to further understand the best imaging modality for lung metastasis surveillance in this patient population.