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Thomas NP, Pierce TT, Ozturk A, Lee SJ, Crawford B, Hennessy DW, Park A, Sagar P, Heng M, Lozano Calderón S. Assessment of the added value of intravenous gadolinium for knee osteosarcoma resection planning in pediatric and young adult patients. J Surg Oncol 2023; 128:1190-1194. [PMID: 37525571 DOI: 10.1002/jso.27415] [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: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND AND OBJECTIVES To assess the impact of Gadolinium-enhanced magnetic resonance imaging (MRI) sequences on Preoperative imaging evaluation and surgical planning parameters for osteosarcoma (OS) of the knee in pediatric and young adult patients. METHODS Thirty MRI scans of patients with OS about the knee were reviewed by five orthopedic oncologists. Key preoperative parameters (neurovascular bundle involvement, intra-articular tumor extension, extent of intramedullary extension) and surgical plans were evaluated based on non-contrast versus Gd contrast enhanced sequences. Assessment agreement, inter-rater agreement, and intrarater agreement between pre and postcontrast images were evaluated via Kappa statistics. RESULTS Moderate agreement was seen between non and contrast-enhanced assessment of neurovascular involvement and intra-articular tumor extension. Intrarater reproducibility was substantial for neurovascular bundle involvement (precontrast Kappa: 0.63, postcontrast Kappa: 0.69). Intrarater reproducibility was also substantial for precontrast (Kappa: 0.70) and moderate for postcontrast (Kappa: 0.50) assessment of intra-articular tumor extension. Planned resection length and choice of surgical approach were similar between sequences. The addition of Gd-enhanced sequences improved the inter-rater agreement across collected parameters. CONCLUSIONS While some findings suggest that contrast enhanced sequences may not significantly alter the assessment of key preoperative planning parameters by orthopedic oncologists, they may help reduce variability among providers with differing experience levels.
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Affiliation(s)
- Nathan P Thomas
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Theodore T Pierce
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Ultrasound Research and Translation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arinc Ozturk
- Center for Ultrasound Research and Translation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stella J Lee
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brooke Crawford
- Deparment of Orthopaedic Surgery, Musculoskeletal Oncology Service, Univerisity of Miami - Miller Medical School, Miami, Florida, USA
| | - David W Hennessy
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Park
- Department of Orthopaedics Surgery, University of Colorado, Aurora, Colorado, USA
| | - Pallavi Sagar
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Santiago Lozano Calderón
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
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Spinal Tumors: Diagnosis and Treatment. J Am Acad Orthop Surg 2022; 30:e1106-e1121. [PMID: 35984082 DOI: 10.5435/jaaos-d-21-00710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/10/2022] [Indexed: 02/01/2023] Open
Abstract
Tumors that present in or around the spine can be challenging to diagnose and treat. A proper workup involves a complete history and physical examination, appropriate staging studies, appropriate imaging of the entire spine, and a tissue biopsy. The biopsy defines the lesion and guides treatment, but in some rare instances, rapid neurological decline may lead to urgent or emergent surgery before it can be analyzed. "Enneking-appropriate" margins should remain the goal for primary tumors while adequate debulking/separation/stabilization are often the goals in metastatic disease. Primary tumors of the spine are rare and often complex tumors to operate on-achieving Enneking-appropriate margins provides the greatest chance of survival while decreasing the chance of local recurrence. Metastatic tumors of the spine are increasingly more common, and timing of surgery must be considered within the greater framework of the patient and the patient's disease, deficits, stability, and other treatments available. The specific tumor type will dictate what other multidisciplinary approaches are available, allowing for chemotherapy and radiation as needed.
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Bodden J, Neumann J, Rasper M, Fingerle AA, Knebel C, von Eisenhart-Rothe R, Specht K, Mogler C, Bollwein C, Schwaiger BJ, Gersing AS, Woertler K. Diagnosis of joint invasion in patients with malignant bone tumors: value and reproducibility of direct and indirect signs on MR imaging. Eur Radiol 2022; 32:4738-4748. [PMID: 35258673 PMCID: PMC9213276 DOI: 10.1007/s00330-022-08586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/15/2021] [Accepted: 01/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the performance and reproducibility of MR imaging features in the diagnosis of joint invasion (JI) by malignant bone tumors. METHODS MR images of patients with and without JI (n = 24 each), who underwent surgical resection at our institution, were read by three radiologists. Direct (intrasynovial tumor tissue (ITT), intraarticular destruction of cartilage/bone, invasion of capsular/ligamentous insertions) and indirect (tumor size, signal alterations of epiphyseal/transarticular bone (bone marrow replacement/edema-like), synovial contrast enhancement, joint effusion) signs of JI were assessed. Odds ratios, sensitivity, specificity, PPV, NPV, and reproducibilities (Cohen's and Fleiss' κ) were calculated for each feature. Moreover, the diagnostic performance of combinations of direct features was assessed. RESULTS Forty-eight patients (28.7 ± 21.4 years, 26 men) were evaluated. All readers reliably assessed the presence of JI (sensitivity = 92-100 %; specificity = 88-100%, respectively). Best predictors for JI were direct visualization of ITT (OR = 186-229, p < 0.001) and destruction of intraarticular bone (69-324, p < 0.001). Direct visualization of ITT was also highly reliable in assessing JI (sensitivity, specificity, PPV, NPV = 92-100 %), with excellent reproducibility (κ = 0.83). Epiphyseal bone marrow replacement and synovial contrast enhancement were the most sensitive indirect signs, but lacked specificity (29-54%). By combining direct signs with high specificity, sensitivity was increased (96 %) and specificity (100 %) was maintained. CONCLUSION JI by malignant bone tumors can reliably be assessed on preoperative MR images with high sensitivity, specificity, and reproducibility. Particularly direct visualization of ITT, destruction of intraarticular bone, and a combination of highly specific direct signs were valuable, while indirect signs were less predictive and specific. KEY POINTS • Direct visualization of intrasynovial tumor was the single most sensitive and specific (92-100%) MR imaging sign of joint invasion. • Indirect signs of joint invasion, such as joint effusion or synovial enhancement, were less sensitive and specific compared to direct signs. • A combination of the most specific direct signs of joint invasion showed best results with perfect specificity and PPV (both 100%) and excellent sensitivity and NPV (both 96 %).
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Affiliation(s)
- Jannis Bodden
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA, 94107, USA.
| | - Jan Neumann
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Rasper
- Department of Radiology, Kantonsspital Muensterlingen, Spitalcampus 1, 8596, Muensterlingen, Switzerland
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Katja Specht
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Pathology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carolin Mogler
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Pathology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christine Bollwein
- Institute of Pathology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Klaus Woertler
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Interdisciplinary Musculoskeletal Tumor Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Goulding KA, Wilke BK, Kiernan HC, Houdek MT, Sherman CE. Skeletal Sarcomas: Diagnosis, Treatment, and Follow-up from the Orthopedic Oncologist Perspective. Radiol Clin North Am 2022; 60:193-203. [DOI: 10.1016/j.rcl.2021.11.001] [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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Shao XH, Li JM, Zhang AL, Yao Y, Sun FF, Li ZZ, Liu T, Cheng K. Discovery and Characterization of Intercondylar Transphyseal Complexes and their Oncological Significance in Transphyseal Extension of Pediatric Osteosarcoma. Orthop Surg 2022; 14:411-421. [PMID: 35199961 PMCID: PMC8867409 DOI: 10.1111/os.13221] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To explore whether there exist undiscovered transphyseal vasculature‐canal compound structures in immature femurs and tibias, and reveal their potential oncological impact. Methods This investigation was divided into a morphological study and a clinical study. In the morphological part, a new‐identified anatomic structure was investigated by using radiographical, anatomical, and histological methodologies. Twenty‐eight 1‐mm‐slice thickness magnetic resonance images of pediatric knees were generated and 10 pediatric knees were dissected to verify the existence and universality, observe the radiographic and anatomic characteristics, and determined the located region of this structure. Hematoxylin–eosin staining, immunofluorescence, and angiography procedures were performed to illustrate its histological feature, molecular identification, and vascular origination, respectively. In the clinical part, 38 pediatric osteosarcoma patients were enrolled from January 2014 to December 2020. A descriptive clinical study including 13 typical participants was conducted to investigate the oncological significance of this new‐identified structure. Meanwhile, the discrepancy in transphyseal osteosarcoma extension between different physeal regions was evaluated in a cross‐sectional study. Results In the morphological study, we discovered a new‐found vasculature‐canal compound structure, intercondylar transphyseal complex (ITC), which originated from the middle genicular vessels, traversed the whole epiphysis, and breached the intact open physis in the immature proximal tibia or distal femur. The components of ITC included the juxta‐articular, epiphyseal, and transphyseal segments of vessels, the canals that traverse the entire epiphysis and physis and enclosed the vessels, vascular foramina on articular facet and foramina‐covered synovium. Depending on the location, ITCs can be divided into three types: femoral ITC, anterior tibial ITC, and posterior tibial ITC. Clinically, the ITC may facilitate intercondylar transphyseal sarcomatous dissemination without damaging the adjacent physeal cartilage. Compared to bilateral condylar physes, more osteosarcomas transgressed the open growth plates through intercondylar regions in which ITC was located (P = 0.022). Conclusion As the “gap” on intact open physis, ITC, which is a new‐identified compound structure in intercondylar regions of immature femur or tibia, may promote intercondylar transphyseal tumor extension. Moreover, the identification and characterization of ITC subvert some traditional comprehensions about physis and may provide novel perspectives for pediatric osteosarcomas.
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Affiliation(s)
- Xian-Hao Shao
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jian-Min Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ai-Lin Zhang
- Rehabilitation Units, University of Canberra Hospital, Bruce, Australian Capital Territory, Australia
| | - Yuan Yao
- Department of Radiography, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fei-Fei Sun
- Department of Pathology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhen-Zhong Li
- Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tao Liu
- Department of Orthopaedics, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Kun Cheng
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Katz TH, Hasan OH, Miller BJ. Accuracy of X-Ray and Magnetic Resonance Imaging in Defining the Tumor Margin in Primary Bone Sarcoma. THE IOWA ORTHOPAEDIC JOURNAL 2021; 41:27-33. [PMID: 34924867 PMCID: PMC8662927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Limb-salvage surgery for primary bone sarcomas are preceded by X-ray and MRI for surgical planning. However, the accuracy of X-ray and MRI predicted margins are not well described. Our study examined these questions: (1) How accurately do X-ray and MRI margin measurements reflect the true margin on pathology reports? (2) Do X-ray or MRI margin measurements have smaller differences compared to pathology reports? (3) How many X-ray or MRI margin measurement differences were greater than 1 cm, 2 cm, and 3 cm from pathology reports? (4) Is there an X-ray or MRI view that consistently results in a smaller difference from pathology reports? METHODS This retrospective chart review examined patients with primary bone sarcoma treated with limb-salvage surgery. Reviewers used electronic measurement tools to determine margins from X-ray or MRI based on the resection length of the pathologic specimen. Mean differences of margin measurements to pathology reports were calculated. We determined outliers of imaging margin measurements at 1 cm, 2 cm, and 3 cm differences to pathology reports. RESULTS In the total cohort of 39 patients, the mean difference of X-ray and MRI margins compared to pathology reports were 1.09 cm (st dev 0.79 cm) and 0.71 cm (st dev 0.70 cm), respectively. MRI margin measurements had smaller differences compared to pathology reports than X-ray in 32 of 38 cases (84%) with complete imaging. X-ray outliers at 1 cm, 2 cm, and 3 cm differences were 36, 14 and 2 respectively for 70 margin measurements and MRI outliers at 1 cm, 2 cm, and 3 cm differences were 17, 6, and 0 respectively for 66 margin measurements. The views with the smallest difference were anterior-posterior X-rays and MRI views with the closest predicted margin. CONCLUSION Electronic MRI margin measurements with the closest predicted margin provided the smallest differences with pathology reports and are therefore the most accurate for preoperative planning. When there is adequate residual diaphysis for reconstructive fixation, surgeons should plan for a 3 cm bone margin using MRI measurements to ensure complete removal of the intramedullary extent of sarcoma.Level of Evidence: IV.
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Affiliation(s)
- Theodore H. Katz
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Obada H. Hasan
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Benjamin J. Miller
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Guedes A, Oliveira MBDR, Melo ASD, Carmo CCMD. Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas. Rev Bras Ortop 2021; 58:179-190. [DOI: 10.1055/s-0041-1736569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/08/2021] [Indexed: 10/19/2022] Open
Abstract
ResumoA evolução na avaliação por imagens dos sarcomas musculoesqueléticos contribuiu para melhora significativa no prognóstico e na sobrevida dos portadores destas neoplasias. A caracterização precisa destas lesões, mediante utilização das modalidades de imagem mais adequadas a cada condição clínica apresentada, é de suma importância no delineamento da abordagem terapêutica a ser instituída, com impacto direto sobre os desfechos clínicos. O presente artigo busca atualizar o leitor a propósito das metodologias de imagem no contexto da avaliação local e sistêmica dos sarcomas ósseos e das partes moles.
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Affiliation(s)
- Alex Guedes
- Grupo de Oncologia Ortopédica, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
| | - Marcelo Bragança dos Reis Oliveira
- Serviço de Traumato-ortopedia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Adelina Sanches de Melo
- Serviço de Medicina Nuclear, Hospital Santa Izabel, Santa Casa da Misericórdia da Bahia, Salvador, BA, Brasil
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Sedaghat S, Sedaghat M, Meschede J, Jansen O, Both M. Diagnostic value of MRI for detecting recurrent soft-tissue sarcoma in a long-term analysis at a multidisciplinary sarcoma center. BMC Cancer 2021; 21:398. [PMID: 33849475 PMCID: PMC8042876 DOI: 10.1186/s12885-021-08113-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/29/2021] [Indexed: 12/19/2022] Open
Abstract
Background Soft-tissue sarcomas (STS) are rare tumors of the soft tissue. Recent diagnostic studies on STS mainly dealt with only few cases of STS and did not investigate the post-therapeutic performance of MRI in a routine clinical setting. Therefore, we assessed the long-term diagnostic accuracy of MRI for detecting recurrent STS at a multidisciplinary sarcoma center. Methods In all, 1055 postoperative follow-up MRIs of 204 patients were included in the study. MRI follow-up scans were systematically reviewed for diagnostic values (true-positive/−negative and false-positive/−negative results) in detecting recurrences. Pathological reports and follow-up MRIs were set as baseline references. Results The median age of the patients was 55.3 ± 18.2 years. Of the patients, 34.8% presented with recurrences. Here, 65 follow-up scans were true positive, 23 false positive, 6 false negative, and 961 true negative. The overall sensitivity and specificity of MRI for detecting recurrences were 92 and 98%, respectively, with an accuracy of 97%. For intramuscular lesions and after surgery alone the sensitivity was higher (95 and 97%, respectively) than for subcutaneous lesions and surgery with additional radiation therapy (83 and 86%, respectively), at similarly high specificities (96–98%). The 6 false-negative results were found in streaky (n = 2) and small ovoid/nodular (n = 4) recurring lesions. The false-positive lesions imitated streaky (n = 14), ovoid/nodular (n = 8), and polycyclic/multilobulated recurring tumors (n = 1). All false-positive results were found in patients in whom the primary tumors were polycyclic/multilobulated in appearance. Conclusion MRI shows a high diagnostic accuracy for detecting recurrent STS, with a high sensitivity and specificity. The diagnostic accuracy decreases in subcutaneous lesions and after surgery with radiation therapy, compared to intramuscular lesions and surgery alone. Radiologists should pay particular attention to streaky and small ovoid/nodular recurring lesions and patients with polycyclic/multilobulated primary tumors.
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Affiliation(s)
- Sam Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Maya Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| | - Jens Meschede
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany.,Department for Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Germany
| | - Olav Jansen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Marcus Both
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Sarcomas in the groin and inguinal canal: A 16-year single-centre experience. J Plast Reconstr Aesthet Surg 2020; 74:768-774. [PMID: 33455868 DOI: 10.1016/j.bjps.2020.12.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/27/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Soft tissue sarcomas arising in the groin and inguinal canal can be difficult to diagnose and manage. This is in part explained by the complex anatomy of the region. Early referral to specialist centres has been advocated, as inadvertent excision of these tumours can jeopardise definitive treatment. We present our 16-year experience at a regional sarcoma service. MATERIALS AND METHODS A retrospective review of patients treated for a sarcoma in the groin and inguinal canal within the North of England Bone and Soft Tissue Tumour Service was performed. Demographic information, along with therapeutic approach and outcomes, was recorded and analysed. RESULTS A total of 67 patients were identified, out of which 18 presented with new lesions, 32 presented after having a previous inadvertent sarcoma excision, 10 had a planned resection and 7 presented with recurrent disease. Liposarcomas were the most common histological subtype (55%), and the spermatic cord the most common origin (45%). Fifty-seven patients had surgery for this condition, with seven incomplete excision. Regional flaps were used in 60% of the cases, to allow an adequate oncological resection and soft tissue cover. Patients who had undergone a previous inadvertent sarcoma excision did not have worse rates of local recurrence, metastases and disease-specific mortality. Kaplan-Meier disease-specific survival at 5 years was 82%. DISCUSSION Inadvertent and inadequate groin sarcoma excision outside of specialist centres remains a problem despite clear guidance. Despite this, an aggressive oncological approach to inadequately managed tumours shows similar outcomes as tumour managed exclusively by our specialist centre.
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Du XH, Wei H, Li P, Yao WT. Artificial Intelligence (AI) Assisted CT/MRI Image Fusion Technique in Preoperative Evaluation of a Pelvic Bone Osteosarcoma. Front Oncol 2020; 10:1209. [PMID: 32850355 PMCID: PMC7417346 DOI: 10.3389/fonc.2020.01209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
Surgeries of pelvic bone tumors are very challenging due to the complexity of anatomical structures and the irregular bone shape. CT and MRI are used in clinic for tumor evaluation, each with its own advantages and shortcomings. Combining the data of both CT and MRI images would take advantage of the merits of both images and provide better model for preoperative evaluation. We utilized an artificial intelligence (AI)-assisted CT/MRI image fusion technique and built a personalized 3-D model for preoperative tumor margin assessment. A young female patient with pelvic osteosarcoma was evaluated with our novel image fusion 3-D model in comparison with the 3-D model based solely on CT images. The fusion image model showed more detailed anatomical information and discovered multiple emboli within veins which were previously neglected. The discovery of emboli implied abysmal prognosis and discouraged any attempts for complex reconstruction after tumor resection. Based on the experience with this pelvic osteosarcoma, we believe that our image fusion model can be very informative with bone tumors. Though further validation with a large number of clinical cases is required, we propose that our model has the potential to benefit the clinic in the preoperative evaluation of bone tumors.
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Affiliation(s)
- Xin-Hui Du
- Department of Orthopedics, Henan Cancer Hospital/Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Hua Wei
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Po Li
- Department of Orthopedics, Henan Cancer Hospital/Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei-Tao Yao
- Department of Orthopedics, Henan Cancer Hospital/Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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