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Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 30 - 31
1 Mar 2008
Narvani A Tsiridis E Ramachandran M Briggs T Cannon S Saifuddin A Mitchell R
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The aim of this study was to compare the accuracy of image guided (ultrasound or CT) percutaneous needle biopsy to percutaneous needle biopsy without image guidance in diagnosis of soft tissue tumours. Eighty-eight consecutive patients with soft tissue lesion who were referred to the soft tissue tumour unit underwent percutaneous needle biopsies of their lesion either with image guidance or without. Sixty-one out of these 88 patients subsequently underwent excision of their lesion and the excised specimen was then subjected to histological examination. The accuracy of image guided percutaneous needle biopsy and percutaneous needle biopsy without image was then calculated by comparing the histological results of the needle biopsy to that of excision biopsy. The diagnosis accuracy of image guided percutaneous needle biopsy was 92% (34 out 37) compared to 79% (22 out of 28) for percutaneous needle biopsy without image. In 3 out of the 28 patients who had percutaneous needle biopsy without image guidance, there was insufficient material obtained from the needle biopsy to allow a histological diagnosis. This was not the case with any of the patients who had image guided percutaneous needle biopsy. Conclusion: Using image guidance, either USS or CT scan, improves the diagnostic accuracy of percutaneous needle biopsy and should be the gold standard technique in management of soft tissue tumours. However, if the lesion is palpable and not mobile, the accuracy of percutaneous needle biopsy without image guidance can be up to 79%


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 190 - 190
1 Mar 2006
Narvani A Tsiridis E Mitchell R Saifuddin A Briggs T Cannon S
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We compared the accuracy of image guided (ultrasound or CT) percutaneous core needle biopsy to percutaneous core needle biopsy without image guidance in diagnosis of soft tissue tumours. 140 patients with soft tissue lesion who were referred to a London bone and soft tissue tumour unit underwent percutaneous core needle biopsies of their lesion either with or without image guidance.111 of these 140 patients subsequently had surgical excision. The accuracy of image guided percutaneous biopsy and percutaneous biopsy without image was then calculated by comparing the histological results of the needle biopsy to that of the resection. The diagnosis accuracy of unguided biopsy was 78% (36 out of 46) compared to 95% (62 out of 65) in image guided. In 6 out of the 46 patients who had unguided biopsy, there was insufficient material obtained from the needle biopsy to allow histological diagnosis. This was not the case with any of the patients who had image guided core needle biopsy. Using image guidance, either USS or CT scan, improves the diagnostic accuracy of percutaneous core needle biopsy and must be considered in management of patients with soft tissue tumours


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_7 | Pages 99 - 99
1 Jul 2020
Shabib AB Al-Jahdali F Aljuhani W Ahmed B Salam M
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Surgical biopsies are still considered the gold standard in obtaining tumor tissue samples. In this study, we will analyze the core needle biopsy in the evaluation of musculoskeletal tumors focusing on the accuracy, effectiveness, and safety of this technique in comparison to an open biopsy procedure. This is a retrospective case series at King Abdulaziz Medical City (KAMC). All medical records from all patients who had a core needle biopsy (CNB) for a musculoskeletal mass and eventually underwent excisional biopsy between January 2010 and December 2016 at KAMC were included. Besides patient demographic data, the data extracted included the locations of the suspected mass, type of tissue acquired (bone or soft tissue), number of biopsies, complications reported during the procedure, histopathological report of core needle biopsy. A total of 262 patients who were suspected to have a musculoskeletal tumor were identified. Female to male ratio was (1:1.4) and paediatrics (of 93.1%. The AUC of CNB in comparison to excisional biopsy was 0.86. The most common site of tumor extraction was in lower extremities (47.3%), followed by upper extremities (23.7%), pelvis and gluteal area (19.5%) and spine (9.5%). In conclusion, CNB is cost-effective, safe and minimally invasive in bony and soft tissue lesions in comparison to an open biopsy procedure. Therefore, initiatives are required to implement this procedure to the majority of health care centers


The Journal of Bone & Joint Surgery British Volume
Vol. 82-B, Issue 1 | Pages 50 - 54
1 Jan 2000
Saifuddin A Mitchell R Burnett SJD Sandison A Pringle JAS

Needle biopsy is an established technique for the histological diagnosis of bone tumours, usually guided by fluoroscopy or CT. Surface lesions and aggressive tumours which have extended through the cortex are also amenable to imaging with ultrasound (US). We have assessed the diagnostic accuracy of US-guided Trucut needle biopsy in a consecutive series of patients referred to a Bone Tumour Unit with suspected primary bone tumours. Of 144 patients (83 men, 61 women; mean age 34.7 years) referred over a period of two years, 63 were considered suitable for US-guided biopsy. This was based on the presence of a relatively large extraosseous component, seen typically in osteosarcoma and malignant round-cell tumours. The results of needle biopsy were compared with those of surgical biopsy. The diagnostic accuracy was 98.4%, with only a single failed biopsy. Thus, in a selected group of patients, US is a very reliable technique of guidance for percutaneous needle biopsy of bone tumours


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_30 | Pages 49 - 49
1 Aug 2013
Smith J Marsh A Hems T Ritchie D
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Although most peripheral nerve sheath tumours are benign, some are malignant. The management of malignant tumours usually involves wide excision and is facilitated by knowledge of the diagnosis prior to operation. Imaging modalities, including MRI, give anatomical information but do not distinguish between benign and malignant nerve tumours. We therefore introduced the use of ultrasound guided needle biopsy for suspected nerve tumours to our unit in 2004. Prior to this, excision biopsy was carried out in all cases. We aimed to review our experience with needle biopsy and determine whether it has an effective role in the management of peripheral nerve tumours. All patients who had a needle biopsy for suspected peripheral nerve tumours from January 2004 to December 2011 were identified from our tumour database and clinical notes reviewed. In all cases, biopsy was carried out under ultrasound guidance with local anaesthesia to obtain a 1mm core of tissue. From 25 patients reviewed, 21 (84%) had a successful biopsy. In 3 cases the biopsy was unable to be completed due to pain and in 1 patient insufficient tumour tissue was obtained. 1 patient had a temporary radial nerve palsy following needle biopsy which recovered fully. In biopsies that were successful, 19 (90%) showed a benign peripheral nerve tumour. Following diagnosis of a benign lesion, only 2 patients required to have surgical excision of the tumour due to pain. The remainder were managed non-operatively. In the 2 cases of malignant tumours detected by biopsy, a successful wide surgical excision was performed. Ultrasound guided core needle biopsy appears safe and gives a tissue diagnosis in most cases of suspected peripheral nerve tumours. In malignant cases it facilitates surgical planning, while most benign tumours could be managed non-operatively, therefore avoiding potential complications of nerve surgery


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 265 - 265
1 Jul 2011
Kiatisevi P Nielsen T Hayes M Munk PL LaFrance AE Clarkson P Masri BA
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Purpose: Core needle biopsy is increasingly accepted for the diagnosis of bone and soft-tissue tumours. Advantages over open biopsy include reduced morbidity, time and cost; however diagnostic accuracy remains a concern. Our objective was to assess and compare the diagnostic accuracy of core needle, open, and fine needle biopsies. Method: We reviewed 286 cases collected in a prospective database between 2004 and 2007. Of these, 229 had core needle, 32 open, and 25 fine needle biopsies. 230 had soft-tissue lesions, 56 had bone lesions. The results of these biopsies were compared to the final resection diagnosis for accuracy and, where inaccurate, any effects on management. Results: Ninety-two percent of the core needle, 100% of the open and 72% of the fine needle biopsies had adequate tissue to make a diagnosis. Of the adequate specimens, the accuracy of core/open/fine needle biopsy was 96%, 97% and 94% for determining malignant versus benign; of the correctly identified malignant lesions 97%, 100% and 80% were accurate for histological grade; and 79%, 84%, 59% for histological subtype. Conclusion: Core needle biopsy yields diagnostic results comparable to open biopsy for determining malignancy and grade in bone and soft-tissue tumours. Fine needle biopsy has a high inadequate sampling rate and should not be used for diagnosing bone and soft-tissue tumours. Given the reduced cost and morbidity associated with core needle biopsies we believe they should be used routinely for diagnosis where possible, and open biopsy reserved for situations where an inadequate specimen is obtained or core biopsy is not feasible


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_IV | Pages 486 - 486
1 Apr 2004
Aluntas A Choong P Powell G Slavin J Smith P Schlicht S Toner G Ngan S
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Introduction The aim of this study was to assess the accuracy of CT-guided core needle biopsy of musculo-skeletal tumours. Methods This is a retrospective study on a series of 127 patients with a musculoskeletal tumours. The biopsies were performed over a four year period from 1998 to 2001. The accuracy of the CT-guided core needle biopsy was determined by comparing the histology of the biopsy with the final histology of the specimen obtained at open biopsy or surgical resection of the tumour. The effective accuracy was determined by the accuracy of the biopsy to diagnose benign versus malignant. Results CT-guided core needle biopsy in this series has an overall accuracy of 80%. The effective accuracy as determined by a malignant versus benign lesion was 89%. There were 86 malignant tumours with a biopsy accuracy of 81% and there were 41 benign tumours with a biopsy accuracy of 78%. The positive predictive value (PPV) of a malignant tumour is 100% and the PPV of benign tumour 94.9%. The most common site of biopsy was from the femur and thigh, together accounting for 39.4% of the tumours. The most common tumours in this series were liposarcoma (n=12), osteosarcoma (n=11) and giant cell tumour (n=11). There were no reported complications arising from the biopsy. Conclusions CT-guided core needle biopsy is a safe and effective procedure that is important in the diagnosis and management of musculoskeletal tumours


The Bone & Joint Journal
Vol. 96-B, Issue 8 | Pages 1098 - 1105
1 Aug 2014
Brown MT Gikas PD Bhamra JS Skinner JA Aston WJS Pollock RC Saifuddin A Briggs TWR

The pre-operative differentiation between enchondroma, low-grade chondrosarcoma and high-grade chondrosarcoma remains a diagnostic challenge. We reviewed the accuracy and safety of the radiological grading of cartilaginous tumours through the assessment of, first, pre-operative radiological and post-operative histological agreement, and second the rate of recurrence in lesions confirmed as high-grade on histology. We performed a retrospective review of major long bone cartilaginous tumours managed by curettage as low grade between 2001 and 2012. A total of 53 patients with a mean age of 47.6 years (8 to 71) were included. There were 23 men and 30 women. The tumours involved the femur (n = 20), humerus (n = 18), tibia (n = 9), fibula (n = 3), radius (n = 2) and ulna (n = 1). Pre-operative diagnoses resulted from multidisciplinary consensus following radiological review alone for 35 tumours, or with the addition of pre-operative image guided needle biopsy for 18. The histologically confirmed diagnosis was enchondroma for two (3.7%), low-grade chondrosarcoma for 49 (92.6%) and high-grade chondrosarcoma for two (3.7%). Three patients with a low-grade tumour developed a local recurrence at a mean of 15 months (12 to 17) post-operatively. A single high-grade recurrence (grade II) was treated with tibial diaphyseal replacement. The overall recurrence rate was 7.5% at a mean follow-up of 4.7 years (1.2 to 12.3). Cartilaginous tumours identified as low-grade on pre-operative imaging with or without additional image-guided needle biopsy can safely be managed as low-grade without pre-operative histological diagnosis. A few tumours may demonstrate high-grade features histologically, but the rates of recurrence are not affected. Cite this article: Bone Joint J 2014; 96-B:1098–105


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 351 - 351
1 Jul 2011
Narvani A Tsiridis E Saifuddin A Briggs T Cannon S
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The aim of this study was to compare accuracy of an image guided percutaneous core needle biopsy (PCNB), using ultrasound or computed tomography, to PCNB without image guidance in the diagnosis of palpable soft tissue tumors. One hundred forty patients with a suspected soft tissue sarcoma underwent a percutaneous core needle biopsy with or without image guidance. One hundred eleven patients had subsequent surgical excision. The accuracy of guided PCNB and blind PCNB was calculated by comparing the histological results of the needle biopsy to the surgical specimen. The diagnostic accuracy of blind percutaneous core needle biopsy was 78% (36 of 46 biopsies) and significantly lower (p ≤ 0.025) in comparison to image guided percutaneous core needle biopsy which was 95% (62 of 65 biopsies). We suggest that image guidance improves the diagnostic accuracy of PCNB especially for small size deep sited suspected soft tissue tumours


The Journal of Bone & Joint Surgery British Volume
Vol. 73-B, Issue 3 | Pages 498 - 500
1 May 1991
Stoker D Cobb J Pringle J

Needle biopsies, performed on 208 consecutive patients and interpreted at the London Bone Tumour Service over a two-year period, were reviewed. A correct diagnosis was reached in 97% (133 out of 137) using this technique alone. Needle biopsy is safe and accurate when undertaken in consultation within a bone tumour service; it offers considerable advantages to both patient and surgeon over conventional open biopsy


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 68 - 68
1 Mar 2010
Péchon P Briggs T Cannon S Pollock R Skinner J Saifuddin A
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Introduction: Pathological fractures commonly undergo biopsy to establish tissue diagnosis and plan definitive surgical management. Methods: 129 patients undergoing image-guided needle biopsy of a pathological fracture between 1998 and 2007 were prospectively identified. Imaging was by CT, ultrasound or fluoroscopy. Biopsy was by Jamshedi, Temno or Trucut needle. The outcome measure was ability to make a tissue diagnosis by this method. Results: The median age at diagnosis was 43 years. 59% were male, 41% female. The four most common sites of pathological fracture were the femur (35%), humerus (28%), tibia (12%) and pelvis (11%). The five most common histopathological diagnoses were chondrosarcoma (9%), osteosarcoma (9%), meta-static renal carcinoma (8%), giant-cell tumour (6%), lymphoma (5%). 77% of biopsies yielded a tissue diagnosis. The remaining 23% underwent open biopsy, repeat image-guided needle biopsy or were not further investigated. In the 30 cases (23%) of non-diagnostic biopsies 80% of these lesions had no extra-osseous component to them and the remaining 20% had a very small extra-osseous component. Discussion: A tissue diagnosis of a pathological fracture can be obtained by primary image-guided needle biopsy in 77% of cases referred to a specialist bone tumour service. The majority (80%) of unsuccessful biopsies were of lesions with little or no extra-osseous component to the lesion


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXX | Pages 35 - 35
1 Jul 2012
Pennant S Gibbons C Whitwell D Ostlere S Morley J
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Introduction. Tissue diagnosis is essential to direct the definitive management of a suspected soft tissue or bone sarcoma tissue. Knowledge of both the diagnostic yield and accuracy of core needle biopsies is therefore important to give the investigating team information on the likelihood of their initial investigations achieving a diagnosis. Methods. This is a retrospective study of patients referred to a specialist orthopaedic centre for investigation of a suspected soft tissue or bone sarcoma. Details of all core needle biopsies performed in a 13-month period were obtained from the hospital database. We defined a diagnostic biopsy as either a specific tissue diagnosis or a biopsy that decided the definitive management of the patient, specifically if malignancy was excluded and no further intervention was required, to calculate the diagnostic yield. Diagnostic accuracy was established by comparing histological diagnosis at biopsy to that at final excision. Results. The overall diagnostic yield of the biopsies performed was 85% (125 of 148 biopsies) and the diagnostic accuracy was 93% (77 of 83). The diagnostic yield of soft tissue lesions was 93% (79 of 85) and accuracy 98%. For bone lesions the diagnostic yield was 73% (46 of 73) and accuracy was 85%. Discussion. Knowing the diagnostic yield and accuracy of biopsies performed allows the investigating team to give patients and colleagues a figure detailing the likely success of a soft tissue or bone biopsy in being diagnostic. In addition this data provides the investigating team with information on specific biopsy types that are less likely to be diagnostic, such as bone lesions requiring CT guidance. These may benefit from another biopsy method to avoid delay in diagnosis and facilitate timely management


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 468 - 468
1 Jul 2010
Cardoso P Massada M Freitas D Pereira A Sousa J
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Core needle: From the other 335, 116 were benign tumours or tumour-like conditions, 86 primary malignant, 53 lesions oh Hematopoietic, lymphoid and biopsy is simple, practical and easily permits diagnosis of bone and soft tissue tumours and tumour-like conditions even when immunohistochemical studies are needed. We present the results of 412 core needle biopsies guided with fluoroscopy, CT and echo scan with assessment of accuracy and costs. From January/96 to December/08, 56 soft tissue and 356 bone tumours and tumour-like lesions were submitted to this technique in the Oncology Unit of Hospital Santo Antònio. All biopsies were performed by the same team (one radiologist, one orthopaedic surgeon) and the histological exam by the same pathologist. There were 77 cases in which diagnosis was inconclusive (sample not representative, crushing, necrosis, hemorrhagic features or image/histological dissociation); 36 of these were soft tissue and 41 bone lesions. histiocytic elements, 65 metastases, 8 recurrent malignancies, 5 osteomyelitis and 2 metabolic diseases. Diagnosis was confirmed in 278 cases with the definitive surgery and only one was wrong. The other 57 cases were later controlled by imaging exams and there were no reasons to suspect a wrong diagnosis. No complications occurred. Costs were estimated to be less than one fifth of an open biopsy. The high accuracy (only one case was misdiagnosis), the safety, the costs and the fact that in only 18,7% the diagnosis was not established make us consider this method effective and to be encouraged. Better selection of lesions and more attention to directions of the cores may low the number of inconclusive diagnosis


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 5 - 5
1 Jan 2011
Pechon P Cannon S Briggs T Pollock R Skinner J Datir A Saifuddin A
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Objectives:. To determine the diagnostic performance of image-guided percutaneous core needle biopsy (CNB) in patients presenting with pathologic fractures of the appendicular skeleton. To determine factors associated with non-diagnostic biopsy and identify cases which should be considered for primary open biopsy. A retrospective audit identified 129 consecutive patients presenting with pathological fractures to a specialist orthopaedic oncology unit over a 9 year period. All patients underwent percutaneous CNB using CT (n=98), fluoroscopy (n=15) or US (n=16) guidance. In all cases MRI or CT was available prior to biopsy to assess the presence and degree of extra-osseous tumour mass. The resulting sample was classified as diagnostic (Group 1) or non-diagnostic (Group 2) on histopathological study. Diagnostic performance was evaluated on the basis of the diagnostic yield and accuracy; these were related to the site of the lesion and presence/absence of extra-osseous mass. Of 129 biopsies, 99 (77%) were classified as Group 1 and 30 (23%) as Group 2. The commonest sites of pathological fracture without associated soft tissue component and resulting in a non-diagnostic biopsy were the proximal femur and proximal humerus. The average cross-sectional diameter of lesions in Group 1 was 5.7 x 5.9cm. Of the 30 lesions comprising Group 2, no soft tissue component was identified on pre-biopsy cross-sectional imaging in 27 lesions (90%) whereas the remaining 3 (10%) showed a smaller extra-osseous soft tissue component compared to the lesions in Group 1. Image-guided percutaneous CNB is a reliable method for obtaining a tissue diagnosis in patients presenting with a pathologic fracture of the appendicular skeleton with high accuracy rate. However, those lesions which are purely intra-osseous or have only very small extra-osseous components are likely to be associated with a non-diagnostic biopsy, and should be considered for a primary open procedure


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_7 | Pages 1 - 1
1 Apr 2014
MCGLYNN J FERGUSON K JANE M RITCHIE D MAHENDRA A
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Introduction. Needle guided biopsy of a suspected musculoskeletal malignancy has become increasingly popular as an effective modality for diagnosis. Biopsy performed in a safe manner should be performed in a centre which is also capable of performing the definitive management of such conditions. Our aim was to determine accuracy and success rates of the image guided biopsies performed by our service. Methods. A retrospective review of the Bone and Soft Tissue Sarcoma service database was performed to identify all patients who underwent diagnostic biopsy and to identify the results of such investigations. A biopsy was deemed successful if a sample of the target lesion was sampled at the time of biopsy. The successful biopsies were then classified as diagnostic or non-diagnostic if the diagnosis could be reached from the sampled tissue. Results. 465 of the 1181 new referrals to the Bone and Soft Tissue Sarcoma service in a 4 year period underwent biopsy. 75% (350) were image guided biopsies – 60% (281) ultrasound and 15% (69) CT guided. The rate of successful ultrasound guided biopsy was 94.7% and the rate of a successful diagnostic biopsy was 93.6%. CT guided biopsies were successful in 95.7% and were both successful and diagnostic in 79.7%. Discussion. The rate of a successful diagnostic ultrasound biopsy within our institution reflects the reported rate within the literature. The rate of a successful diagnostic CT guided biopsy is lower however is also consistent with that reported within the literature. Lipomatous and cartilaginous lesions are associated with a more difficult histological diagnosis on biopsy alone which is consistent with our findings. For this reason our institution has stopped performing routine image guided biopsies on these lesions


The Journal of Bone & Joint Surgery British Volume
Vol. 75-B, Issue 6 | Pages 977 - 978
1 Nov 1993
Davies N Livesley P Cannon


The Bone & Joint Journal
Vol. 106-B, Issue 1 | Pages 99 - 106
1 Jan 2024
Khal AA Aiba H Righi A Gambarotti M Atherley O'Meally AO Manfrini M Donati DM Errani C

Aims. Low-grade central osteosarcoma (LGCOS), a rare type of osteosarcoma, often has misleading radiological and pathological features that overlap with those of other bone tumours, thereby complicating diagnosis and treatment. We aimed to analyze the clinical, radiological, and pathological features of patients with LGCOS, with a focus on diagnosis, treatment, and outcomes. Methods. We retrospectively analyzed the medical records of 49 patients with LGCOS (Broder’s grade 1 to 2) treated between January 1985 and December 2017 in a single institute. We examined the presence of malignant features on imaging (periosteal reaction, cortical destruction, soft-tissue invasion), the diagnostic accuracy of biopsy, surgical treatment, and oncological outcome. Results. Based on imaging, 35 of 49 patients (71.4%) exhibited malignant features. Overall, 40 of 49 patients (81.6%) had undergone a biopsy before en-bloc resection: 27 of 40 patients (67.5%) were diagnosed on the first biopsy, which was more accurate when carried out by open rather than needle biopsy (91.3% vs 35.3% diagnostic accuracy, respectively; p < 0.001). Of the 40 patients treated by en-bloc resection, surgical margins were wide in 38 (95.0%) and marginal in two (5.0%). Furthermore, nine of 49 patients (18.4%) underwent curettage (intralesional margin) without previous biopsy. All patients with a positive margin developed local recurrence. Distant metastases occurred in five of 49 patients (10.2%). The mean five-year overall survival (OS) and distant relapse-free survival (D-RFS) were 89.3% (SD 5.1%) and 85.7% (SD 5.5%), respectively. Univariate analysis showed that the occurrence of distant metastasis was a poor prognostic factor for OS (hazard ratio 11.54, 95% confidence interval (CI) 1.92 to 69.17; p < 0.001). Local recurrence was a poor prognostic factor for D-RFS (HR 8.72, 95% CI 1.69 to 45.0; p = 0.002). Conclusion. The diagnosis of LGCOS can be challenging because it may present with non-malignant features and has a low diagnostic accuracy on biopsy. If precisely diagnosed, LGCOS can be successfully treated by surgical excision with wide margins. Cite this article: Bone Joint J 2024;106-B(1):99–106


Bone & Joint 360
Vol. 12, Issue 6 | Pages 39 - 42
1 Dec 2023

The December 2023 Oncology Roundup. 360. looks at: A single osteotomy technique for frozen autograft; Complications, function, and survival of tumour-devitalized autografts used in patients with limb-sparing surgery; Is liquid nitrogen recycled bone and vascular fibula the biological reconstruction of choice?; Solitary pulmonary metastases at first recurrence of osteosarcoma; Is a radiological score able to predict resection-grade chondrosarcoma in primary intraosseous lesions of the long bones?; Open versus core needle biopsy in lower-limb sarcoma – current practice patterns and patient outcomes; Natural history of intraosseous low-grade chondroid lesions of the proximal humerus; Local treatment modalities and event-free survival in patients with localized Ewing’s sarcoma; Awaiting biopsy results in solitary pathological proximal femoral fractures


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_13 | Pages 102 - 102
1 Dec 2022
Gundavda M Lazarides A Burke Z Griffin A Tsoi K Ferguson P Wunder JS
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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


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 77 - 77
1 Jan 2011
Jennings R Riley ND Rose B Rossi R Saifuddin A Skinner JA Cannon SR Briggs TWR Pollock R
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Introduction: Chondrosarcoma is the second most common primary malignant bone tumour. Distinguishing between grades is not necessarily straightforward and may alter the management of the disease. We evaluated the correlation between the pre-operative needle biopsy and excision biopsy histological grading of chondrosarcoma of the femur, tibia and humerus. Methods: A consecutive retrospective series of 100 patients with a histological diagnosis of chondrosarcoma made at a supra-regional bone tumour unit was reviewed. Twenty-one patients were excluded because 20 had only excision biopsy, due to radiological confidence in the diagnosis, and one had only the pre-operative biopsy on record, thus this series included 79 available cases. The remaining patients underwent a pre-operative needle biopsy. Results: In 11 instances, there was a discrepancy in histological grade. Therefore, there was an 86% (68 out of 79) accuracy rate for pre-operative histological grading of chondrosarcoma, based on needle biopsy. However, the accuracy of the diagnostic biopsy to distinguish low-grade from high-grade was 90% (71 out of 79). Discussion: From this series we conclude that accurate image-guided biopsy is a very useful adjunct in determining histological grade of chondrosarcoma and the subsequent treatment plan. At present, a multidisciplinary approach, comprising experienced Orthopaedic Surgeons, Radiologists and Pathologists offers the most reliable means of accurately diagnosing and grading chondrosarcoma of long bones