Diagnosis is usually clinical. Ultrasound is not routinely required to confirm the diagnosis, except in the case of masses that meet the red flag criteria below:

Sarcoma red flags

  1. Bigger than 4.3cm (based on NICE guidelines, think of a golf ball)
  2. Increasing in size.
  3. Slow growth of a clinically suspected lipoma is within normal limits.
  4. Deep to fascia (i.e. Less obvious when muscle is contracted)
  5. Painful
  6. Recurrence of a previously excised benign tumour

If any of these features are present, an urgent ultrasound should be requested. Alternatively, if there is high clinical suspicion of sarcoma in an enlarging mass, the 2ww pathway should be used.

If 2 or more are present a 2 week wait sarcoma referral should be made. This automatically books the patient for an ultrasound appointment with a consultant radiologist, who can liaise with the MDT.

If 3 or more of the features are present, there is an 80% chance of a malignant lesion.

Following imaging

The patient will either be referred to the Sarcoma MDT meeting or returned to the care of the GP with explicit management recommendations on the US report.

If there is significant persistent pain that is not solely pressure related and/or rapid growth (doubling in size in 3 months is a guide), a repeat scan is indicated. If there are any queries following imaging, the Radiology email advice service can be used: rch-tr.GPRadiologyEnquiries@nhs.net.

There is currently no commissioned pathway for large, symptomatic lipomas that have been deemed benign on imaging and returned to the care of the GP.

In cases of exceptional /unique clinical need, the GP may wish to make an individual funding request.