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Stokes CM, Elsewaisy O, Pang G, Slavin JL, Schlicht SM, Choong PFM. Diagnostic accuracy of computed tomography-guided biopsy in pathological fractures. ANZ J Surg 2017; 87:600-604. [PMID: 28304116 DOI: 10.1111/ans.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/23/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obtaining a histological diagnosis is essential for appropriate management of pathological fractures. Computed tomography (CT) is an accurate method of obtaining diagnosis for musculoskeletal tumours. We analysed whether diagnostic accuracy was maintained in the evaluation of pathological fractures. METHODS A retrospective review of 101 consecutive patients presenting to our tertiary musculoskeletal tumour centre with pathological fracture was performed. Patients underwent core needle biopsy under CT guidance of pathological fractures diagnosed by plain radiography and either CT or magnetic resonance imaging. The histopathology of the CT-guided biopsy was compared with the sample obtained from open biopsy or definitive surgery to determine diagnostic accuracy. RESULTS The mean age at diagnosis was 52 ± 20 years (range: 18-85) in a cohort of 46 men and 55 women. Diagnostic accuracy of CT-guided biopsy was 82.18%. There were 65 malignant and 36 benign tumours with diagnostic accuracy of 86.15% and 80.56%, respectively. The positive predictive value for a malignant tumour was 98.21% whilst it was 93.1% for benign tumours. The femur (53 cases) and humerus (25 cases) were the commonest bones fractured. The most frequent diagnoses were metastasis (20.79%), giant cell tumour (17.82%), osteosarcoma (9.90%) and myeloma (9.90%). There were no complications of CT-guided biopsy. CONCLUSION Pathological fracture does not confound the diagnosis of musculoskeletal tumours. CT-guided biopsy is an accurate diagnostic tool in the evaluation of pathological fractures. Final diagnosis and management should be made in the context of appropriate anatomical and functional imaging using a multidisciplinary approach.
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Affiliation(s)
- Christopher M Stokes
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Osama Elsewaisy
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Grant Pang
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia.,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John L Slavin
- Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Stephen M Schlicht
- Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Imaging, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria, Australia.,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Preoperative core biopsy of soft-tissue tumours facilitates their surgical management: 10-year update: Reply. ANZ J Surg 2009. [DOI: 10.1111/j.1445-2197.2009.04906.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee MK, Choong PF, Smith PJ, Powell GJ, Slavin JL, Schlicht SM. Pigmented villonodular synovitis of the hip mimicking soft-tissue sarcoma: a case report. J Orthop Surg (Hong Kong) 2006; 14:76-80. [PMID: 16598093 DOI: 10.1177/230949900601400117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pigmented villonodular synovitis is a rare and benign but potentially locally aggressive disease that should be considered in younger patients who present with monoarticular joint symptoms and pathology. We present a 30-year-old Sudanese woman with a huge mass arising from the right hip joint. A multimodality radiological approach to investigation and diagnosis is demonstrated and discussed. Histopathological examination of the resected specimen confirmed the diagnosis of pigmented villonodular synovitis with the mass consisting of a proliferation of fibrohistiocytic cells, abundant haemosiderin, foamy histiocytes, and occasional giant cells. The patient made a good recovery, with mobility aided by arm crutches and a hip abduction brace.
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Affiliation(s)
- M Ks Lee
- Department of Radiology, St Vincent's Hospital, Fitzroy, Melbourne, Australia.
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