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Caracciolo JT, Ali S, Chang CY, Degnan AJ, Flemming DJ, Henderson ER, Kransdorf MJ, Letson GD, Madewell JE, Murphey MD. Bone Tumor Risk Stratification and Management System: A Consensus Guideline from the ACR Bone Reporting and Data System Committee. J Am Coll Radiol 2023; 20:1044-1058. [PMID: 37855758 DOI: 10.1016/j.jacr.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 10/20/2023]
Abstract
The assessment and subsequent management of a potentially neoplastic bone lesion seen at diagnostic radiography is often complicated by diagnostic uncertainty and inconsistent management recommendations. Appropriate clinical management should be directed by risk of malignancy. Herein, the ACR-sponsored Bone Reporting and Data System (Bone-RADS) Committee, consisting of academic leaders in the fields of musculoskeletal oncology imaging and orthopedic oncology, presents the novel Bone-RADS scoring system to aid in risk assignment and provide risk-aligned management suggestions. When viewed in the proper clinical context, a newly identified bone lesion can be risk stratified as having very low, low, intermediate, or high risk of malignancy. Radiographic features predictive of risk are reviewed include margination, pattern of periosteal reaction, depth of endosteal erosion, pathological fracture, and extra-osseous soft tissue mass. Other radiographic features predictive of histopathology are also briefly discussed. To apply the Bone-RADS scoring system to a potentially neoplastic bone lesion, radiographic features predictive of risk are each given a point value. Point values are summed to yield a point total, which can be translated to a Bone-RADS score (1-4) with corresponding risk assignment (very low, low, intermediate, high). For each score, evidence-based and best practice consensus management suggestions are outlined. Examples of each Bone-RADS scores are presented, and a standardized diagnostic radiography report template is provided.
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Affiliation(s)
- Jamie T Caracciolo
- Senior Member and Professor, Diagnostic Imaging, Section Head, Musculoskeletal Imaging, Moffitt Cancer Center, Tampa, Florida.
| | - Sayed Ali
- Professor of Radiology, Section Chief of Musculoskeletal Radiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Connie Y Chang
- Associate Professor of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew J Degnan
- Radiologist, Section Chief of Pediatric Radiology, Abington Hospital-Jefferson Health, UPMC Children's Hospital of Pittsburgh, Abington, Pennsylvania
| | - Donald J Flemming
- Professor of Radiology and Orthopaedics and Diagnostic Radiology Residency Program Director, Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Eric R Henderson
- Associate Professor of Orthopaedic Surgery Adjunct Associate Professor of Engineering, Norris Cotton Cancer Center, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
| | | | - George Douglas Letson
- Physician in Chief of the Moffitt Medical Group, Moffitt Cancer Center, Tampa, Florida
| | - John E Madewell
- Professor and Chair ad interim Musculoskeletal Imaging, MD Anderson Cancer Center, Houston, Texas
| | - Mark D Murphey
- Physician-in-Chief, American Institute for Radiologic Pathology, Silver Spring, Maryland
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Song M, Liu H, Zhang L, Gao L. Intraosseous hibernoma in the rib. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:ivac287. [PMID: 36802252 PMCID: PMC9931074 DOI: 10.1093/icvts/ivac287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023]
Abstract
A 64-year-old man was admitted with paroxysmal left-side thoracic pain. CT scan showed an irregular appearance, expansile, osteolytic lesion of the left seventh rib. Wide en bloc excision of the tumour was performed. Macroscopic examination showed that a 3.5 cm × 3.0 cm × 3.0 cm solid lesion with destruction of bone. Histological examination showed that the tumour cells were arranged in plate shaped and interspersed between the bone trabeculae. Mature adipocytes were noted in the tumour tissues. The immunohistochemical stainings showed that the vacuolated cells were positive for S-100 protein and negative for CD68 and CD34. These clinicopathological features were consistent with intraosseous hibernoma.
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Affiliation(s)
- Minglei Song
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei, China
| | - Hui Liu
- Department of Computed Tomography, The Fourth Hospital of Hebei Medical University, Hebei, China
| | - Lingling Zhang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Hebei, China
| | - Liping Gao
- Corresponding author. Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei, China, No. 12 Jiankang Road, Shijiazhuang, Hebei 050011, China. Tel: +86 031186095353; e-mail: (L. Gao)
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Jaiswal LS, Neupane D. Benign rib tumors: a case series from tertiary care Centre of Nepal and review of literature. J Surg Case Rep 2021; 2021:rjab518. [PMID: 34858577 PMCID: PMC8634075 DOI: 10.1093/jscr/rjab518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 01/15/2023] Open
Abstract
Rib tumors are rare. They can present with wide varieties of symptoms and differentiating benign from malignant lesions is challenging. A careful history and supporting investigations can help to reach the definite diagnosis. Surgical resection is the treatment of choice with excellent prognosis. A total of four patients were operated for the management of rib tumors over a period of 5 years at our institution. All four were benign lesions and included simple bone cyst, fibrous dysplasia with aneurysmal bone cyst, aneurysmal bone cyst and enchondroma. There were three male and one female. None of them is having recurrence till now. Surgical resection is the treatment of choice for benign rib tumors as it provides diagnostic and curative treatment.
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Affiliation(s)
| | - Durga Neupane
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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Osteosarcoma of the rib: A challenge of diagnosis and surgical intervention: A case report. Int J Surg Case Rep 2021; 81:105777. [PMID: 33887851 PMCID: PMC8041722 DOI: 10.1016/j.ijscr.2021.105777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Chest wall tumour could grow from various tissues composing the chest wall. Diagnosis and treatment of patients with chest wall tumour pose several challenges. CASE PRESENTATION We present a case of 55 year old woman with chief complaint of a painfull mass on her chest wall. Patient was diagnosed with osteosarcoma of the ribs. Patient underwent surgery and was hospitalized for seven days before discharged. CLINICAL DISCUSSION Osteosarcoma of the ribs is a rare case with wide resection as the main treatment. In this case, chest wall reconstruction was needed to prevent impaired chest wall mechanical function in respiration. CONCLUSION Diagnosis and treatment of osteosarcoma of the ribs pose challenges. The main treatment of the osteosarcoma of the ribs is wide resection, followed by reconstruction of chest wall when needed. Reconstruction could be performed with autologous tissue, gore-tex, and mesh. The adjuvant chemotherapy was considered to give for better outcome.
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Chen CC, Su YJ. Rib Fibrous Dysplasia Mimicking Extrapleural Hematoma. J Emerg Med 2016; 51:e147-e148. [PMID: 27712894 DOI: 10.1016/j.jemermed.2016.07.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Chang-Chih Chen
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
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Rubin AN, Byrns K, Zhou D, Freedman L. Fibrous Dysplasia of the Rib:AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics 2015; 35:2049-52. [DOI: 10.1148/rg.2015140335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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