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Guedes A, Nakagawa SA. Biopsy of bone tumors: a literature review. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S131. [PMID: 38865550 PMCID: PMC11164262 DOI: 10.1590/1806-9282.2024s131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Alex Guedes
- Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Orthopedic Oncology Group – Salvador (BA), Brazil
| | - Suely Akiko Nakagawa
- Reference Center for Bone Tumors and Sarcomas, A.C.Camargo Cancer Center – São Paulo (SP), Brazil
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2
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Drews MA, Milosevic A, Hamacher R, Grüneisen JS, Haubold J, Opitz MK, Bauer S, Umutlu L, Forsting M, Schaarschmidt BM. Impact of CT and MRI in the diagnostic workup of malignant triton tumour-a monocentric analysis and review of the literature. Br J Radiol 2024; 97:430-438. [PMID: 38308031 DOI: 10.1093/bjr/tqad035] [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: 08/14/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES Malignant triton tumours (MTTs) are rare but aggressive subtypes of malignant peripheral nerve sheath tumours (MPNSTs) with a high recurrence rate and 5-year survival of 14%. Systematic imaging data on MTTs are scarce and mainly based on single case reports. Therefore, we aimed to identify typical CT and MRI features to improve early diagnosis rates of this uncommon entity. METHODS A systematic review on literature published until December 2022 on imaging characteristics of MTTs was performed. Based on that, we conducted a retrospective, monocentric analysis of patients with histopathologically proven MTTs from our department. Explorative data analysis was performed. RESULTS Initially, 29 studies on 34 patients (31.42 ± 22.6 years, 12 female) were evaluated: Literature described primary MTTs as huge, lobulated tumours (108 ± 99.3 mm) with central necrosis (56% [19/34]), low T1w (81% [17/21]), high T2w signal (90% [19/21]) and inhomogeneous enhancement on MRI (54% [7/13]). Analysis of 16 patients (48.9 ± 13.8 years; 9 female) from our institution revealed comparable results: primary MTTs showed large, lobulated masses (118 mm ± 64.9) with necrotic areas (92% [11/12]). MRI revealed low T1w (100% [7/7]), high T2w signal (100% [7/7]) and inhomogeneous enhancement (86% [6/7]). Local recurrences and soft-tissue metastases mimicked these features, while nonsoft-tissue metastases appeared unspecific. CONCLUSIONS MTTs show characteristic features on CT and MRI. However, these do not allow a reliable differentiation between MTTs and other MPNSTs based on imaging alone. Therefore, additional histopathological analysis is required. ADVANCES IN KNOWLEDGE This largest published systematic analysis on MTT imaging revealed typical but unspecific imaging features that do not allow a reliable, imaging-based differentiation between MTTs and other MPNSTs. Hence, additional histopathological analysis remains essential.
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Affiliation(s)
- Marcel A Drews
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Aleksandar Milosevic
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Rainer Hamacher
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147 Essen, Germany
| | - Johannes S Grüneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Marcel K Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Sebastian Bauer
- West German Cancer Centre, Department of Medical Oncology, University Hospital Essen, 45147 Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
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Ariyaratne SP, Purohit N, Botchu R. A novel technique for performing aspiration biopsies - A technical report. J Clin Orthop Trauma 2024; 48:102339. [PMID: 38312319 PMCID: PMC10831271 DOI: 10.1016/j.jcot.2024.102339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
An aspiration biopsy is a commonly performed procedure for diagnostic sampling, particularly for sampling of cystic soft tissue lesions and bone marrow. The method is also useful for diagnostic sampling of bone lesions, particularly cystic and lytic osseous lesions where traditional methods of core biopsy may yield little to no material. Performing a successful aspiration biopsy involves aspiration of the lesion's contents and curettage of the walls. This requires maintaining a constant negative pressure on the syringe, which can be challenging with bone biopsies, as it requires one hand to maintain significant pressure on the plunger while the other hand manipulates the needle within the lesion. We describe a novel technique for performing aspiration biopsies of these lesions which allows maintenance of constant negative pressure on the syringe and frees up both the proceduralist's hands for better control of the needle.
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Affiliation(s)
- Sisith P. Ariyaratne
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Neeraj Purohit
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
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Hegde G, Iyengar KP, Kurisunkal V, Sharma GK, Ariyaratne S, Botchu R. Current role and future applications of image-guided interventional procedures in musculoskeletal oncology - A narrative review. J Orthop 2023; 44:99-106. [PMID: 37746308 PMCID: PMC10514383 DOI: 10.1016/j.jor.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023] Open
Abstract
Background Musculoskeletal (MSK) image-guided interventional procedures have been increasingly used in and remain crucial in the diagnosis and treatment of musculoskeletal tumours. Aims In this article, we aim to describe commonly performed interventional procedures in the subspeciality of MSK oncology drawing experience from our tertiary referral centre. Recent advances, emerging techniques and future applications of image-guided interventional procedures in the field of MSK oncology are highlighted. Material and methods A retrospective search using the keyword 'musculoskeletal system', 'neoplasms', 'biopsy', and 'interventional radiology' was performed at our tertiary care oncology orthopaedic referral centre radiology database. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS). Electronic Patient Records, histopathology laboratory records and patient characteristics were collaborated to generate this narrative experience at our centre. Results Image-guided interventional procedures have been utilised in a spectrum of primary and secondary MSK tumours. Current applications include diagnosis of bone and soft tissue MSK neoplastic lesions with biopsies, thermal, cryotherapy and Radiofrequency ablations and augmentation procedures. Conclusion Musculoskeletal (MSK) image-guided interventions have increasing applications in the diagnosis, management, treatment and monitoring of patients with MSK tumours. The emergence of newer imaging technologies with enhanced skills of interventional radiologists will allow a range of therapeutic MSK interventions in both effective control of primary lesions and palliative care of metastatic lesions.
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Affiliation(s)
- Ganesh Hegde
- Department of Musculoskeletal Radiology, Royal National Orthopedic Hospital, Stanmore, UK
| | | | - Vineet Kurisunkal
- Department of Orthopedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Sisith Ariyaratne
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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McCrum C, Furner R, Grainger S. Peri-procedural management and incidence of bleeding events following musculoskeletal injections or aspirations in people on oral anticoagulation and antiplatelet therapy. Musculoskeletal Care 2023; 21:702-712. [PMID: 36806477 DOI: 10.1002/msc.1743] [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: 01/20/2023] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Corticosteroid injections and aspirations are common interventions for managing musculoskeletal and inflammatory conditions. However, there remains limited safety evidence to support injection decisions and peri-procedural management in people on anti-thrombotics, particularly for direct oral anticoagulants (DOACs). OBJECTIVES To investigate peri-procedural management and bleeding complications following musculoskeletal injections or aspirations with anti-thrombotic medication use. DESIGN A prospective observational study was undertaken (October 2018-December 2020) in Orthopaedics, Rheumatology and Radiology specialities in two large UK healthcare providers. Data collection involved weekly identification of musculoskeletal procedures, emergency attendance or admission within 30 days and follow-up questionnaires sent within 2 weeks post-procedure. Descriptive statistics were used to analyse anticoagulant/anti-platelet use, peri-procedural management and bleeding complications. RESULTS Of 5080 procedures, 237 of 1338 responses reported antithrombotic use: warfarin (n = 36), DOACs (n = 75) and antiplatelets (n = 126). There were no self-report or electronic identification of clinically significant bleeding events/complications. Only local bruising was reported (8.6% vs. 0.2% with non-use), and only with medication continuation or international normalised ratio (INR) levels ≥3.8 or unknown. Only 3/72 DOAC use was interrupted. CONCLUSIONS In this study, no clinically significant bleeding events or complications were reported or identified following musculoskeletal injections or aspirations, with only localised bruising reported. It was not universal practice to check INR levels and DOAC interruption was uncommon. Findings add evidence that musculoskeletal procedures appear to be low risk procedures for bleeding complications with antithrombotic continuation and when INR levels within lower target range. Research on intra-articular or soft tissue iatrogenic consequences would add to risk/benefit evaluations.
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Affiliation(s)
- Carol McCrum
- Research Centre for Health Professions, University of Brighton, Eastbourne, UK
- East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK
- Rheumatology Department, Canberra Health Service, Canberra, Australian Capital Territory, Australia
| | - Rosie Furner
- East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK
| | - Sally Grainger
- East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK
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LaPrade CM, Andryk LM, Christensen JL, Neilson JC, Wooldridge AN, Hackbarth DA, Bedi M, King DM. Natural history of intraosseous low-grade chondroid lesions of the proximal humerus. Front Oncol 2023; 13:1200286. [PMID: 37637054 PMCID: PMC10457155 DOI: 10.3389/fonc.2023.1200286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Enchondromas and grade 1 chondrosarcomas are commonly encountered low-grade chondroid tumors in the proximal humerus. While there is a concern for malignant transformation, few studies have evaluated the natural history of these lesions. The purpose of this study is to evaluate the natural history of proximal humerus low-grade chondroid lesions managed both conservatively and surgically, and to define management criteria using clinical and radiographic findings for these low-grade chondroid lesions. Methods The patient population included 90 patients intended for conservative treatment and 22 patients proceeding directly to surgery. Data collection was based on a combination of chart review and patient imaging and descriptive statistics were calculated for each group. Results No malignant transformations were noted amongst any group. In the conservative treatment group, 7 of 64 (11%) progressed to surgery after an average of 20.3 months of conservative treatment due to persistent pain unexplained by other shoulder pathology. Importantly, 71% experienced continued pain at a mean of 53.1 months post-operatively. The group that went directly to surgery also demonstrated pain in 41% at an average follow-up of 57.3 months. Discussion Low-grade cartilaginous lesions of the proximal humerus without concerning imaging findings can be managed with conservative treatment and the risk of malignant transformation is very low. Patients with a clear source of their shoulder pain unrelated to their tumor and without concerning characteristics on imaging can be managed with serial annual radiographic imaging. Patients undergoing surgery for these indolent tumors are likely to experience persistent pain even after surgery.
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Affiliation(s)
| | - Logan M. Andryk
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joshua L. Christensen
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - John C. Neilson
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Adam N. Wooldridge
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Donald A. Hackbarth
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Manpreet Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David M. King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
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Hu Y, Li A, Zhao CK, Ye XH, Peng XJ, Wang PP, Shu H, Yao QY, Liu W, Liu YY, Lv WZ, Xu HX. A multiparametric clinic-ultrasomics nomogram for predicting extremity soft-tissue tumor malignancy: a combined retrospective and prospective bicentric study. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01639-0. [PMID: 37154999 DOI: 10.1007/s11547-023-01639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE We aimed at building and testing a multiparametric clinic-ultrasomics nomogram for prediction of malignant extremity soft-tissue tumors (ESTTs). MATERIALS AND METHODS This combined retrospective and prospective bicentric study assessed the performance of the multiparametric clinic-ultrasomics nomogram to predict the malignancy of ESTTs, when compared with a conventional clinic-radiologic nomogram. A dataset of grayscale ultrasound (US), color Doppler flow imaging (CDFI), and elastography images for 209 ESTTs were retrospectively enrolled from one hospital, and divided into the training and validation cohorts. A multiparametric ultrasomics signature was built based on multimodal ultrasomic features extracted from the grayscale US, CDFI, and elastography images of ESTTs in the training cohort. Another conventional radiologic score was built based on multimodal US features as interpreted by two experienced radiologists. Two nomograms that integrated clinical risk factors and the multiparameter ultrasomics signature or conventional radiologic score were respectively developed. Performance of the two nomograms was validated in the retrospective validation cohort, and tested in a prospective dataset of 51 ESTTs from the second hospital. RESULTS The multiparametric ultrasomics signature was built based on seven grayscale ultrasomic features, three CDFI ultrasomic features, and one elastography ultrasomic feature. The conventional radiologic score was built based on five multimodal US characteristics. Predictive performance of the multiparametric clinic-ultrasomics nomogram was superior to that of the conventional clinic-radiologic nomogram in the training (area under the receiver operating characteristic curve [AUC] 0.970 vs. 0.890, p = 0.006), validation (AUC: 0.946 vs. 0.828, p = 0.047) and test (AUC: 0.934 vs. 0.842, p = 0.040) cohorts, respectively. Decision curve analysis of combined training, validation and test cohorts revealed that the multiparametric clinic-ultrasomics nomogram had a higher overall net benefit than the conventional clinic-radiologic model. CONCLUSION The multiparametric clinic-ultrasomics nomogram can accurately predict the malignancy of ESTTs.
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Affiliation(s)
- Yu Hu
- Department of Medical Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ao Li
- Department of Medical Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China.
| | - Xin-Hua Ye
- Department of Medical Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Jing Peng
- Department of Medical Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ping-Ping Wang
- Department of Medical Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hua Shu
- Department of Medical Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qi-Yu Yao
- Department of Medical Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Liu
- Department of Medical Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun-Yun Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology, Wuhan, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
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He S, Zhong A, Lei J, Deng Z, Zhu X, Wei R, Huang H, Chen Z, Cai L, Xie Y. Application of Indocyanine Green Fluorescence Imaging in Assisting Biopsy of Musculoskeletal Tumors. Cancers (Basel) 2023; 15:cancers15082402. [PMID: 37190330 DOI: 10.3390/cancers15082402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: Biopsies are the gold standard for the diagnosis of musculoskeletal tumors. In this study, we aimed to explore whether indocyanine green near-infrared fluorescence imaging can assist in the biopsy of bone and soft tissue tumors and improve the success rate of biopsy. (2) Method: We recruited patients with clinically considered bone and soft tissue tumors and planned biopsies. In the test group, indocyanine green (0.3 mg/kg) was injected. After identifying the lesion, a near-infrared fluorescence camera system was used to verify the ex vivo specimens of the biopsy in real time. If the biopsy specimens were not developed, we assumed that we failed to acquire lesions, so the needle track and needle position were adjusted for the supplementary biopsy, and then real-time imaging was performed again. Finally, we conducted a pathological examination. In the control group, normal biopsy was performed. (3) Results: The total diagnosis rate of musculoskeletal tumors in the test group was 94.92% (56/59) and that in the control group was 82.36% (42/51). In the test group, 14 cases were not developed, as seen from real-time fluorescence in the core biopsy, and then underwent the supplementary biopsy after changing the puncture direction and the location of the needle channel immediately, of which 7 cases showed new fluorescence. (4) Conclusions: Using the near-infrared fluorescence real-time development technique to assist the biopsy of musculoskeletal tumors may improve the accuracy of core biopsy and help to avoid missed diagnoses, especially for some selected tumors.
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Affiliation(s)
- Siyuan He
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Ang Zhong
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jun Lei
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhouming Deng
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Xiaobin Zhu
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Renxiong Wei
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Huayi Huang
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhenyi Chen
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Lin Cai
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yuanlong Xie
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Ong W, Zhu L, Tan YL, Teo EC, Tan JH, Kumar N, Vellayappan BA, Ooi BC, Quek ST, Makmur A, Hallinan JTPD. Application of Machine Learning for Differentiating Bone Malignancy on Imaging: A Systematic Review. Cancers (Basel) 2023; 15:cancers15061837. [PMID: 36980722 PMCID: PMC10047175 DOI: 10.3390/cancers15061837] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
An accurate diagnosis of bone tumours on imaging is crucial for appropriate and successful treatment. The advent of Artificial intelligence (AI) and machine learning methods to characterize and assess bone tumours on various imaging modalities may assist in the diagnostic workflow. The purpose of this review article is to summarise the most recent evidence for AI techniques using imaging for differentiating benign from malignant lesions, the characterization of various malignant bone lesions, and their potential clinical application. A systematic search through electronic databases (PubMed, MEDLINE, Web of Science, and clinicaltrials.gov) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 34 articles were retrieved from the databases and the key findings were compiled and summarised. A total of 34 articles reported the use of AI techniques to distinguish between benign vs. malignant bone lesions, of which 12 (35.3%) focused on radiographs, 12 (35.3%) on MRI, 5 (14.7%) on CT and 5 (14.7%) on PET/CT. The overall reported accuracy, sensitivity, and specificity of AI in distinguishing between benign vs. malignant bone lesions ranges from 0.44–0.99, 0.63–1.00, and 0.73–0.96, respectively, with AUCs of 0.73–0.96. In conclusion, the use of AI to discriminate bone lesions on imaging has achieved a relatively good performance in various imaging modalities, with high sensitivity, specificity, and accuracy for distinguishing between benign vs. malignant lesions in several cohort studies. However, further research is necessary to test the clinical performance of these algorithms before they can be facilitated and integrated into routine clinical practice.
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Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Correspondence: ; Tel.: +65-67725207
| | - Lei Zhu
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Yi Liang Tan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Ee Chin Teo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Beng Chin Ooi
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Allen H, Barnthouse NC, Chan BY. Periosteal Pathologic Conditions: Imaging Findings and Pathophysiology. Radiographics 2023; 43:e220120. [DOI: 10.1148/rg.220120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hailey Allen
- From the Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Nicholas C. Barnthouse
- From the Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Brian Y. Chan
- From the Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
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Acro-osteolysis: imaging, differential diagnosis, and disposition review. Skeletal Radiol 2023; 52:9-22. [PMID: 35969258 DOI: 10.1007/s00256-022-04145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/02/2023]
Abstract
Acro-osteolysis is the osseous destruction of the hand or foot distal phalanges. The categories of the disease include terminal tuft, midshaft, or mixed types. Recognition of acro-osteolysis is straightforward on radiographs, but providing an accurate differential diagnosis and appropriately recommending advanced imaging or invasive tissue diagnosis can be more elusive. A radiologist's ability to provide advanced assessment can greatly aid clinicians in expedient diagnosis and management of the array of diseases presenting with acro-osteolysis.
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Wright A, Desai M, Bolan CW, Badawy M, Guccione J, Rao Korivi B, Pickhardt PJ, Mellnick VM, Lubner MG, Chen L, Elsayes KM. Extraskeletal Ewing Sarcoma from Head to Toe: Multimodality Imaging Review. Radiographics 2022; 42:1145-1160. [PMID: 35622491 DOI: 10.1148/rg.210226] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Extraskeletal Ewing sarcoma (EES) is a rare subtype in the Ewing sarcoma family of tumors (ESFT), which also includes Ewing sarcoma of bone (ESB) and, more recently, primitive neuroectodermal tumors. Although these tumors often have different manifestations, they are grouped on the basis of common genetic translocation and diagnosis from specific molecular and immunohistochemical features. While the large majority of ESFT cases occur in children and in bones, approximately 25% originate outside the skeleton as EES. Importantly, in the adult population these extraskeletal tumors are more common than ESB. Imaging findings of EES tumors are generally nonspecific, with some variation based on location and the tissues involved. A large tumor with central necrosis that does not cross the midline is typical. Despite often nonspecific findings, imaging plays an important role in the evaluation and management of ESFT, with MRI frequently the preferred imaging modality for primary tumor assessment and local staging. Chest CT and fluorine 18 fluorodeoxyglucose PET/CT are most sensitive for detecting lung and other distant or nodal metastases. Management often involves chemotherapy with local surgical excision, when possible. A multidisciplinary treatment approach should be used given the propensity for large tumor size and local invasion, which can make resection difficult. Despite limited data, outcomes are similar to those of other ESFT cases, with 5-year survival exceeding 80%. However, with metastatic disease, the long-term prognosis is poor. ©RSNA, 2022.
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Affiliation(s)
- Alexandra Wright
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Madhura Desai
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Candice W Bolan
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Mohamed Badawy
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Jeffrey Guccione
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Brinda Rao Korivi
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Perry J Pickhardt
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Vincent M Mellnick
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Meghan G Lubner
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Longwen Chen
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
| | - Khaled M Elsayes
- From the Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (A.W., M.B., B.R.K., K.M.E.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.D., C.W.B.); Department of Radiology, The University of Texas Health Science Center at Houston, Tex (J.G.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (V.M.M.); and Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (L.C.)
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13
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Wong GS, Bass D, Chen IY, Thomas R, Velez MJ, Hobbs SK. Imaging and Clinical Findings in a Series of Six Cases of Rare Primary Mediastinal Liposarcoma. Radiol Cardiothorac Imaging 2022; 4:e210259. [PMID: 35506134 DOI: 10.1148/ryct.210259] [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: 09/27/2021] [Revised: 01/03/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
Abstract
Primary mediastinal liposarcoma is a rare, fat-containing malignant lesion that can manifest incidentally with varied imaging appearances. The size and location within the mediastinum can vary among patients. Here, the authors describe the clinical presentation, radiographic characteristics, management, and prognosis in a series of six patients with primary mediastinal liposarcoma. The following case series suggests that even simple-appearing fatty intrathoracic lesions may lead to the development of malignant imaging features. Keywords: Conventional Radiography, CT, MR Imaging, PET/CT, Soft Tissues/Skin, Thorax, Mediastinum ©RSNA, 2022.
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Affiliation(s)
- Gordon S Wong
- School of Medicine and Dentistry (G.S.W.), Department of Imaging Sciences (D.B., S.K.H.), Department of Pathology and Laboratory Medicine (I.Y.C., M.J.V.), and Department of Gastroenterology (R.T.), University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - David Bass
- School of Medicine and Dentistry (G.S.W.), Department of Imaging Sciences (D.B., S.K.H.), Department of Pathology and Laboratory Medicine (I.Y.C., M.J.V.), and Department of Gastroenterology (R.T.), University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Irene Y Chen
- School of Medicine and Dentistry (G.S.W.), Department of Imaging Sciences (D.B., S.K.H.), Department of Pathology and Laboratory Medicine (I.Y.C., M.J.V.), and Department of Gastroenterology (R.T.), University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Raymond Thomas
- School of Medicine and Dentistry (G.S.W.), Department of Imaging Sciences (D.B., S.K.H.), Department of Pathology and Laboratory Medicine (I.Y.C., M.J.V.), and Department of Gastroenterology (R.T.), University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Moises J Velez
- School of Medicine and Dentistry (G.S.W.), Department of Imaging Sciences (D.B., S.K.H.), Department of Pathology and Laboratory Medicine (I.Y.C., M.J.V.), and Department of Gastroenterology (R.T.), University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Susan K Hobbs
- School of Medicine and Dentistry (G.S.W.), Department of Imaging Sciences (D.B., S.K.H.), Department of Pathology and Laboratory Medicine (I.Y.C., M.J.V.), and Department of Gastroenterology (R.T.), University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
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14
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Morag Y, Lucas DR. Ultrasound of myxofibrosarcoma. Skeletal Radiol 2022; 51:691-700. [PMID: 34292352 DOI: 10.1007/s00256-021-03869-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023]
Abstract
The ultrasound appearance of myxofibrosarcoma is highly variable corresponding to its variable and at times heterogeneous histopathologic appearance. Myxofibrosarcomas may mimic a benign process and the infiltrative tumor margins may be difficult to precisely delineate on ultrasound imaging. These tumor characteristics pose a diagnostic challenge on ultrasound evaluation. The radiologist should be aware of the variable morphologic presentation and infiltrative nature of myxofibrosarcoma and the limitations of ultrasound in the initial diagnosis, biopsy guidance, and post-surgical follow-up of this tumor.
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Affiliation(s)
- Yoav Morag
- Department of Radiology, University of Michigan, Michigan Medicine Health System, Taubman Center 2910F, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA.
| | - David R Lucas
- Department of Pathology, University of Michigan, Michigan Medicine Health System, Ann Arbor, MI, 48109-5326, USA
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15
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Mosku N, Heesen P, Studer G, Bode B, Spataro V, Klass ND, Kern L, Scaglioni MF, Fuchs B. Biopsy Ratio of Suspected to Confirmed Sarcoma Diagnosis. Cancers (Basel) 2022; 14:cancers14071632. [PMID: 35406402 PMCID: PMC8996854 DOI: 10.3390/cancers14071632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Determining the biology of mesenchymal tumor, imaging alone is usually not enough, and the final diagnosis is established through tissue analysis If the indication to perform a biopsy is not established frequently enough, an undesired unplanned resection of a sarcoma may result, and conversely, a patient’s discomfort as well as costs may increase. In here, using a real-world data registry of quality, we included the absolute number of a consecutive series of patients, to determine the prevalence of biopsies and its related diagnosis, to establish a reference, which may allow for the definition of a quality indicator for the work-up within a multidisciplinary team. Abstract The ratio of malignancy in suspicious soft tissue and bone neoplasms (RMST) has not been often addressed in the literature. However, this value is important to understand whether biopsies are performed too often, or not often enough, and may therefore serve as a quality indicator of work-up for a multidisciplinary team (MDT). A prerequisite for the RMST of an MDT is the assessment of absolute real-world data to avoid bias and to allow comparison among other MDTs. Analyzing 950 consecutive biopsies for sarcoma-suspected lesions over a 3.2-year period, 55% sarcomas were confirmed; 28% turned out to be benign mesenchymal tumors, and 17% non-mesenchymal tumors, respectively. Of these, 3.5% were metastases from other solid malignancies, 1.5% hematologic tumors and 13% sarcoma simulators, which most often were degenerative or inflammatory processes. The RMST for biopsied lipomatous lesions was 39%. The ratio of unplanned resections was 10% in this series. Reorganizing sarcoma work-up into integrating practice units (IPU) allows the assessment of real-world data with absolute values over the geography, thereby enabling the definition of quality indicators and addressing cost efficiency aspects of sarcoma care.
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Affiliation(s)
- Nasian Mosku
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Philip Heesen
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Gabriela Studer
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Beata Bode
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Vito Spataro
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Natalie D. Klass
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Lars Kern
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Mario F. Scaglioni
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
| | - Bruno Fuchs
- Faculty of Medicine, University of Lucerne, 6000 Lucerne, Switzerland; (N.M.); (G.S.); (M.F.S.)
- Swiss Sarcoma Network, 6000 Lucerne, Switzerland; (P.H.); (B.B.); (V.S.); (N.D.K.); (L.K.)
- Correspondence: ; Tel.: +41-41-229-50-00
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16
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Zandee EY, Wu J, Deshmukh S. Troubleshooting Challenging Musculoskeletal Tumor Biopsies: Tricks of the Trade. Semin Roentgenol 2022; 57:275-290. [DOI: 10.1053/j.ro.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
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17
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Stanborough RO, Long JR, Garner HW. Bone and Soft Tissue Tumors. Radiol Clin North Am 2022; 60:311-326. [DOI: 10.1016/j.rcl.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Mills MK, Leake RL, Crawford AM, Soltanolkotabi M, Hansford BG. Concepts in Musculoskeletal Bone and Soft Tissue Biopsy. Semin Musculoskelet Radiol 2021; 25:711-724. [PMID: 34937112 DOI: 10.1055/s-0041-1735471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Imaging-guided needle biopsy of musculoskeletal lesions is a high-yield and low-risk procedure that can be used for definitive characterization of indeterminate bone and soft tissue lesions. Familiarity with the preprocedural, technical, and postprocedural steps is vital for the appropriate management of these cases. Biopsy request triage requires an awareness of definitively benign conditions and other tumor mimics. A complete clinical, laboratory, and imaging work-up is essential for procedural planning and determining pathologic concordance. Consultation with an orthopaedic oncologist is a requisite step to ensure maximizing biopsy yield and to avoid interference with any future limb-sparing surgical intervention. Knowledge of the equipment, pertinent medications, and appropriate biopsy technique can minimize the risk of periprocedural complications. Finally, the radiologist may be required to discuss the concordance of histopathology with preprocedure imaging, perform repeat image-guided biopsy, and carefully interpret sarcoma surveillance imaging examinations.
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Affiliation(s)
- Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Richard L Leake
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Amanda M Crawford
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Maryam Soltanolkotabi
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Barry G Hansford
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
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19
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Li NP, Wingfield MA, Mills MK, Beckett BR, Hansford BG. Percutaneous image-guided sternal biopsy: a cross-institutional retrospective review of diagnostic yield and safety in 50 cases. Skeletal Radiol 2021; 50:495-504. [PMID: 32815039 DOI: 10.1007/s00256-020-03587-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Image-guided sternal biopsy may be technically daunting given the immediately subjacent critical structures. There is a paucity of literature describing technique, safety, and efficacy. This study aims to quantify the diagnostic yield and safety of image-guided sternal biopsies. Secondary aims include (1) describing the preferred approach/technique and (2) identifying imaging features and disease entities associated with higher and lower diagnostic yields. MATERIALS AND METHODS A retrospective review of 50 image-guided sternal biopsies performed at two quaternary care centers from 2000 to 2019 was performed. Recorded lesion-related variables included as follows: location, density, extraosseous extension, and size. Recorded variables from electronic medical records included as follows: patient demographics, histologic or microbiological diagnosis, and complications. Recorded technique-related variables included as follows: needle obliquity, type, and gauge; biopsy core number and length; and modality. RESULTS Of the 50 biopsies, 88.0% resulted in a definitive histologic diagnosis. Six biopsies were non-diagnostic. The majority of biopsies were performed under computed tomography (88.0%), followed by ultrasound (12.0%). Tumor was the most common biopsy indication (90.0%), followed by infection (10.0%). Of the diagnostic biopsies indicated for tumor, 88.9% were malignant. Seventy-four percent of the lesions were predominantly lytic. Fifty percent of lesions had extraosseous extension. Lesion locations were as follows: manubrium (48.0%), sternal body (48.0%), and sternomanubrial joint (4.0%). No minor or major, acute, or delayed procedure-related complications were encountered. CONCLUSION Image-guided sternal biopsy is an efficacious and safe method of obtaining a definitive histologic diagnosis regardless of lesion-specific features or location.
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Affiliation(s)
- Ningcheng Peter Li
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Molly A Wingfield
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, USA
| | - Brooke R Beckett
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Barry G Hansford
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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20
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Soft tissue pathology for the radiologist: a tumor board primer with 2020 WHO classification update. Skeletal Radiol 2021; 50:29-42. [PMID: 32743671 DOI: 10.1007/s00256-020-03567-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023]
Abstract
Radiologists serve an important role in the diagnosis and staging of soft tissue tumors, often through participation in multidisciplinary tumor board teams. While an important function of the radiologist is to review pertinent imaging and assist in the differential diagnosis, a critical role is to ensure that there is concordance between the imaging and the pathologic diagnosis. This requires a basic understanding of the pathology of soft tissue tumors, particularly in the case of diagnostic dilemmas or incongruent imaging and histologic features. This work is intended to provide an overview of soft tissue pathology for the radiologist to optimize participation in multidisciplinary orthopedic oncology tumor boards, allowing for contribution to management decisions with expertise beyond image interpretation.
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21
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Dalili D, Isaac A, Bazzocchi A, Åström G, Bergh J, Lalam R, Weber MA, Fritz J, Mansour R. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation. Semin Musculoskelet Radiol 2020; 24:692-709. [PMID: 33307585 DOI: 10.1055/s-0040-1719103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Musculoskeletal (MSK) image-guided oncologic intervention is an established field within radiology. Numerous studies have described its clinical benefits, safety, cost effectiveness, patient satisfaction, and improved quality of life, thereby establishing image-guided oncologic intervention as a preferred pathway in treating patients presenting with specific benign MSK tumors. But there is a paradigm shift on the horizon because these techniques may also support established pillars (surgery, systemic treatment, radiotherapy) in the treatment of malignant MSK tumors. Unlike benign tumors, where they are used as primary therapy lines with curative intent, such interventions can be selected for malignant tumors as adjuvant treatment in painful or unstable bone or soft tissue lesions or as more palliative therapy strategies. Using examples from our clinical practices, we elaborate on the benefits of applying a multidisciplinary approach (traditionally involving MSK radiologists, oncologists, orthopaedic surgeons, microbiologists, pathologists, physiotherapists, and pain management experts), ideally within a sarcoma treatment center to deliver a patient-specific therapy plan and illustrate methods to assess the benefits of this model of care.In this article, we review the current repertoire of ablation techniques, demonstrate why such procedures offer value-based alternatives to conventional treatments of specific tumors, and reflect on future directions. Additionally, we review the advantages and limitations of each technique and offer guidance to improve outcomes.
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Affiliation(s)
- Danoob Dalili
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital Stockholm, Sweden
| | - Radhesh Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York
| | - Ramy Mansour
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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