Pulmonary Surveillance Strategies Following Sarcoma Excision Vary Among Orthopedic Oncologists: A Survey of the Musculoskeletal Tumor Society.

Background: Pulmonary surveillance protocols following sarcoma excision based on clinical evidence and outcomes are limited in current literature. The purpose of this study was to determine the method, frequency, and reasoning behind pulmonary surveillance strategies in patients treated for sarcoma among members of the Musculoskeletal Tumor Society (MSTS).
Methods: SurveyMonkey, an online survey tool, was used to create and distribute a questionnaire to 211 members of the MSTS in 2011. The 16 questions focused on current pulmonary surveillance algorithms and their reasoning.
Results: Of the surveyed members of the MSTS, 65% follow high-grade sarcoma with routine chest CT scans. Most disagreement involved low-grade sarcomas, where radiographs (34%), routine CT (33%), or selective CT scans (31%) were evenly distributed. Selective CT scans in low-grade lesions were warranted with an indeterminate nodule on prior CT (81%), local recurrence (40%), or large/ deep tumor characteristics (31%). Most protocols were based on continuation of training protocols (46%), clinician's interpretation of the current literature (23%), or personal experience (14%).
Conclusions: Significant clinician variability exists in terms of pulmonary surveillance of sarcomas, most notably in low-grade lesions. The results of this study represent an area in need of further study to develop an evidence-based protocol for sarcoma pulmonary surveillance.