Cartilage lesions vary in the spectrum from benign enchondromas to highly malignant dedifferentiated chondrosarcomas. From the treatment perspective, enchondromas are observed, Grade 1 chondrosarcomas are curetted like aggressive benign tumors, and rest are resected like other sarcomas. Although biopsy for tissue diagnosis is the gold standard for diagnosis and grade determination in chondrosarcoma, tumor heterogeneity limits the grading in patients following a biopsy. In the absence of definite pre-treatment grading, a surgeon is therefore often in a dilemma when deciding the best treatment option. Radiology has identified aggressive features and aggressiveness scores have been used to try and grade these tumors based on the imaging characteristics but there have been very few published reports with a uniform group and large number of cases to derive a consistent scoring and correlation. The authors asked these study questions :(1) Does Radiology Aggressiveness and its Score correlate with the grade of chondrosarcoma? (2) Can a cut off Radiology Agressiveness Score value be used to guide the clinician and add value to needle biopsy information in offering histological grade dependent management?. A retrospective analysis of patients with long bone extremity intraosseous primary chondrosarcomas were correlated with the final histology grade for the operated patients and Radiological parameters with 9 parameters identified a priori and from published literature (radiology aggressiveness scores - RAS) were evaluated and tabulated. 137 patients were identified and 2 patients were eliminated for prior surgical intervention. All patients had tissue diagnosis available and pre-treatment local radiology investigations (radiographs and/or CT scans and MRI scans) to define the RAS parameters. Spearman correlation has indicated that there was a significant positive association between RAS and final histology grading of long bone primary intraosseous chondrosarcomas. We expect higher RAS values will provide grading information in patients with inconclusive pre-surgery biopsy to tumor grades and aid in correct grade dependant surgical management of the lesion. Prediction of dedifferentiated chondrosarcoma from higher RAS will be attempted and a correlation to obtain a RAS cut off, although this may be challenging to achieve due to the overlap of features across the intermediate grade, high grade and dedifferentiated grades. Radiology Aggressiveness correlates with the histologic grade in long bone extremity primary chondrosarcomas and the correlation of radiology and biopsy can aid in treatment planning by guiding us towards a low-grade neoplasm which may be dealt with intralesional extended curettage or high-grade lesion which need to be resected. Standalone RAS may not solve the grading dilemma of primary long bone intraosseous chondrosarcomas as the need for tissue diagnosis for confirming atypical cartilaginous neoplasm cannot be eliminated, however in the event of a needle biopsy grade or inconclusive open biopsy it may guide us towards a correlational diagnosis along with radiology and pathology for grade based management of the chondrosarcoma

Low grade chondrosarcoma is currently followed up with the same schedule as all other chondrosarcoma patients. When treated adequately, low grade chondrosarcoma appears to have a very benign follow up course. Patients and Methods:. A retrospective study of follow ups was done on fifty six patients treated for chondrosarcoma at the Pretoria musculoskeletal tumour unit from 1987–2009, evaluating the outcome and presence of local recurrence. The lesions were divided into four histological grades; atypical enchondroma (grade 0), low grade chondrosarcoma (grade 1), intermediate grade chondrosarcoma (grade 2), and high grade chondrosarcoma (grade3). Results:. Biopsy revealed forty-six patients with low grade chondrosarcoma (82%), nine cases of grade 2 chondrosarcoma (16%), and one patient with a metastatic mesenchymal chondrosarcoma. The femur and humerus were the commonest sites involved, while the axial skeleton was only affected in three cases, all of whom had more aggressive lesions. Forty-nine patients had no recurrence after a mean period of 57.5 months follow up. Forty- two of those had low grade lesions, and seven patients had grade 2 lesions. Two patients with low grade lesions were lost to follow up. Three patients involved in the study presented with local recurrence, but no metastases were detected radiographically. Two patients died, one with metastatic mesenchymal chondrosarcoma involving the scapula, and the other with a grade 2 lesion of the pelvis. Conclusion:. We believe that adequately treated low grade chondrosarcomas have a very low local recurrence rate. When faced with recurrence, it rarely presents with distant metastases. A revised schedule of visits at 3 and 6 months followed by yearly visits for five years appears to be adequate for timely detection and treatment of any local recurrence