Mcaddy NC, Hallin M, Strauss D, et al. - Given the recognized discrepancy between the grading of retroperitoneal leiomyosarcoma (LMS) at initial core biopsy (CB) and surgical excision, concerns regarding the accuracy of CB for directing neoadjuvant therapy are raised. Researchers here proposed and evaluated a combined grading system that combines CT scan findings into presurgical grading. They performed retrospective, blinded review of CT, CB histology and final surgical histology of 53 patients with retroperitoneal LMS who fulfilled criteria for inclusion. They derived a modified grading system, _CTH-Grade, by replacing the CB necrosis score with a CT-derived necrosis score. The analysis revealed that due to the undersampling of tumor necrosis, histology from CB under-grades LMS. CT was identified as more sensitive in assessing necrosis and hence its inclusion into a modified CT-histopathology grading system (_CTH-Grade) could enhance the accuracy of grading with significant implications for patient management.