Preoperative radiographic and histopathologic evaluation of central chondrosarcoma

Abstract

BackgroundDistinguishing grade 1 chondrosarcoma from grade 2 chondrosarcoma is critical both for planning the surgical procedure and for predicting the outcome. We aimed to review the preoperative radiographic and histologic findings, and to evaluate the reliability of preoperative grading.MethodsWe retrospectively reviewed the medical records of 17 patients diagnosed with central chondrosarcoma at our institution between 1996 and 2011. In these cases, we compared the preoperative and postoperative histologic grades, and evaluated the reliability of the preoperative histologic grading. We also assessed the preoperative radiographic findings obtained using plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI).ResultsPreoperative histologic grade was 1 in 12 patients, 2 in 4 patients, and 3 in 1 patient. However, 6 of the 12 cases classified as grade 1 before surgery were re-classified as grade 2 postoperatively. In the radiographic evaluation, grade 1 was suspected by the presence of a ring-and-arc pattern of calcification on plain radiography and CT and entrapped fat and ring-and-arc enhancement on MRI. Grades 2 and 3 were suspected by the absence of calcification and the presence of cortical penetration and endosteal scalloping on plain radiography and CT, as well as soft-tissue mass formation on MRI.ConclusionAlthough the combination of radiographic interpretation and histologic findings may improve the accuracy of preoperative grading in chondrosarcoma, the establishment of a standard evaluation system with the histologic and radiographic findings and/or the development of new biologic markers are necessary for preoperative discrimination of low-grade chondrosarcoma from high-grade chondrosarcoma.

Is Needle Biopsy Clinically Useful in Preoperative Grading of Central Chondrosarcoma of the Pelvis and Long Bones?

“…Similar results are described in the literature, where concordance between histological grade in preoperative biopsy and the final pathological analysis varies from 65% to 86% [8,13,24,25,27]. In our study, the concordance between needle biopsy and surgical specimen for histological grade, in pelvic chondrosarcomas, was poor (36% [14 of 39]), in agreement with other published studies [15,21].…”

“…Although histological patterns for enchondroma and chondrosarcoma have been well described, they are not easy to recognize in small biopsies and the diagnosis is nearly always made with the support of clinical and radiological findings [2,5,7,8,11,14,22,27]. Not only can the distinction between benign and malignant be misleading, but also the grading of malignant lesions may differ significantly, even among experts [8,25].…”

“…Clinical manifestations and radiological features are used, alone or correlated with histology, to make therapeutic decisions [2,5,7,11,14,22,27]. Surgery remains the only curative treatment for patients with central (intramedullary) chondrosarcoma.…”

The impact of biopsy sampling errors and the quality of surgical margins on local recurrence and survival in chondrosarcoma

“…Although the histological features of cartilaginous tumors have been described in detail, they remain a diagnostic challenge in terms of preoperative biopsies, and diagnosis relies on clinical and radiological findings. 4 – 7 Biopsy sampling errors were relatively rare and did not affect DSS and LRFS in our cohort. However, a secondary resection was required in two cases with a previously assumed low-grade lesion.…”

“…Although preoperative histological grading has been associated with a high inter- and intra-rater variability in cartilaginous tumors, imaging-guided biopsy remains the standard diagnostic procedure in chondrosarcoma. 4 – 7 In combination with clinical and radiological diagnostics, it primarily directs therapeutic decision-making. Complete surgical resection remains the gold standard of treatment since chemotherapy and radiation therapy are not effective.…”