Technical aspects of ultrasound in the evaluation of soft tissue tumors

Soft tissue masses are commonly encountered in musculoskeletal radiology practice. Ultrasound is usually the first-line imaging modality for the assessment of these lesions. Ultrasound is inexpensive, readily available, and safe. Its main limitations are operator dependence and the need for appropriate experience. Most soft tissue lesions are benign. The role of the operator is to confidently differentiate benign from malignant lesions. This can be achieved by making full use of the capabilities that ultrasound can offer, from obtaining a detailed clinical history and performing a physical examination to applying additional ultrasound techniques that may improve diagnostic confidence. At the end of the ultrasound assessment, the operator may be able to classify the lesion into one of three main categories: benign, malignant or indeterminate. Benign lesions can often be safely discharged, malignant lesions require biopsy, while indeterminate lesions require further workup and may necessitate biopsy or imaging follow-up. This article aims to provide technical tips and pointers to maximize the effectiveness of ultrasound in achieving a diagnosis. It highlights the importance of the clinical encounter, relevant clinical history and physical signs, common pitfalls, and tips for overcoming technical difficulties during scanning.