Team Approach: Evaluation and Management of Low-Grade Cartilaginous Lesions

Sullivan, Connor W.; Kazley, Jillian; Murtaza, Hamza; Cooley, Michael B.; Jones, David; DiCaprio, Matthew R.

doi:10.2106/jbjs.rvw.19.00054

Cited by 9 publications

(11 citation statements)

References 43 publications

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“…[2][3][4]9,19 This is because complications and the negative side-effects of surgery make it relevant to evaluate whether active surveillance through wait-and-scan is safe. 13,14,[19][20][21][22] Our study has a large series of patients with radiologically diagnosed ACTs and MRI follow-up of up to six times. Furthermore, all MRIs were performed in a tertiary sarcoma centre with a dedicated bone tumour protocol.…”

Section: Discussionmentioning

confidence: 99%

Wait-and-scan: an alternative for curettage in atypical cartilaginous tumours of the long bones

Scholte,

Dorleijn,

Krijvenaar

et al. 2024

Bone Joint J

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AimsDue to its indolent clinical behaviour, the treatment paradigm of atypical cartilaginous tumours (ACTs) in the long bones is slowly shifting from intralesional resection (curettage) and local adjuvants, towards active surveillance through wait-and-scan follow-up. In this retrospective cohort study performed in a tertiary referral centre, we studied the natural behaviour of ACT lesions by active surveillance with MRI. Clinical symptoms were not considered in the surveillance programme.MethodsThe aim of this study was to see whether active surveillance is safe regarding malignant degeneration and local progression. In total, 117 patients were evaluated with MRI assessing growth, cortical destruction, endosteal scalloping, periosteal reaction, relation to the cortex, and perilesional bone marrow oedema. Patients received up to six follow-up scans.ResultsAt the time of the first follow-up MRI, 8% of the lesions showed growth (n = 9), 86% remained stable (101), and 6% decreased in size (n = 7). During the third follow-up, with a mean follow-up time of 60 months (SD 23), 24 patients were scanned, of whom 13% had lesions that had grown and 13% lesions that had decreased in size. After 96 months (SD 37), at the sixth follow-up MRI, 100% of the lesions remained stable. None of the lesions showed malignant progression and although some lesions grew in size (mean 1 mm (SD 0.8)), no malignant progression occurred.ConclusionWe conclude that active surveillance with MRI is safe for ACTs in the long bones in the short- and mid-term follow-up.Cite this article: Bone Joint J 2024;106-B(1):86–92.

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Section: Discussionmentioning

confidence: 99%

Wait-and-scan: an alternative for curettage in atypical cartilaginous tumours of the long bones

Scholte,

Dorleijn,

Krijvenaar

et al. 2024

Bone Joint J

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“…Changes in the WHO classification from chondrosarcoma grade 1 of the long bones to atypical cartilaginous tumor (ACT), together with the recent insight of low transformation risk of ACTs (<1%), has resulted in a more conservative treatment approach of ACTs in literature [1,2,6,7]. Many authors have questioned if the negative side effects of surgical treatment outweigh the potential benefits and; therefore, proposed active surveillance [6,8,10,12,[14][15][16]. To support development of evidence-based guidelines for active surveillance, we studied the natural course of enchondroma and ACTs in the long bones.…”

Section: Discussionmentioning

confidence: 99%

“…Due to these new insights, the most recent literature on cartilaginous tumors shifts towards active surveillance for ACTs in the long bones to avoid unnecessary surgeries [8][9][10][11]. Several authors have studied active surveillance for central cartilaginous tumors in the long bones without aggressive imaging characteristics (e.g., cortical destruction, soft tissue expansion) [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Midterm MRI Follow-Up of Untreated Enchondroma and Atypical Cartilaginous Tumors in the Long Bones

Deckers

Rooy

Flucke

et al. 2021

Cancers

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Management of atypical cartilaginous tumors (ACTs) in the long bones is shifting towards active surveillance to avoid unnecessary surgeries. The frequency and duration of active surveillance for these tumors is unclear as there is little knowledge of its biological behavior. In this retrospective study, we examined the natural course of enchondroma and ACTs through active surveillance. A total of 128 central cartilaginous tumors, located in the long bones, with a minimum interval of 24 months between baseline and last MRI were included. MRI characteristics (e.g., size, scalloping, fat entrapment) were scored and tumors were classified according to the changes between MRIs. Mean follow-up of this study was 50 months, range = 25–138 months. The majority of the cartilaginous tumors (87%) remained stable (n = 65) or showed regression (n = 46) on MRI. A total of 87% of the cases that developed tumor regression presented with entrapped fat at diagnosis. Only 13% (n = 17) showed some progression on MRI, although none of the tumors developed characteristics of high-grade chondrosarcoma. Based on our results, active surveillance is considered safe for enchondroma and ACTs of the long bones. We propose active surveillance for all asymptomatic enchondroma or ACTs in the long bones irrespective of tumor size, and follow-up schemes should be tailored on natural course.

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“…Many authors have proposed radiographic follow-up protocols instead of biopsy for lesions without signs of local aggressiveness (cortical destruction and soft tissue extension), resulting in lower morbidity and costs [ 75 , 76 , 79 , 80 ]. The most recent studies on cartilaginous tumors have shifted toward active surveillance of ACTs to avoid unnecessary surgeries [ 80 , 81 , 82 ].…”

Section: Diagnostic Dilemma Of Chondrosarcoma Classificationmentioning

confidence: 99%

Classification of Chondrosarcoma: From Characteristic to Challenging Imaging Findings

Kim

Lee

2023

Cancers

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Chondrosarcomas can be classified into various forms according to the presence or absence of a precursor lesion, location, and histological subtype. The new 2020 World Health Organization (WHO) Classification of Tumors of Soft Tissue and Bone classifies chondrogenic bone tumors as benign, intermediate (locally aggressive), or malignant, and separates atypical cartilaginous tumors (ACTs) and chondrosarcoma grade 1 (CS1) as intermediate and malignant tumors. respectively. Furthermore, the classification categorizes chondrosarcomas (including ACT) into eight subtypes: central conventional (grade 1 vs. 2–3), secondary peripheral (grade 1 vs. 2–3), periosteal, dedifferentiated, mesenchymal, and clear cell chondrosarcoma. Most chondrosarcomas are the low-grade, primary central conventional type. The rarer subtypes include clear cell, mesenchymal, and dedifferentiated chondrosarcomas. Comprehensive analysis of the characteristic imaging findings can help differentiate various forms of chondrosarcomas. However, distinguishing low-grade chondrosarcomas from enchondromas or high-grade chondrosarcomas is radiologically and histopathologically challenging, even for experienced radiologists and pathologists.

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Team Approach: Evaluation and Management of Low-Grade Cartilaginous Lesions

Cited by 9 publications

References 43 publications

Wait-and-scan: an alternative for curettage in atypical cartilaginous tumours of the long bones

Wait-and-scan: an alternative for curettage in atypical cartilaginous tumours of the long bones

Midterm MRI Follow-Up of Untreated Enchondroma and Atypical Cartilaginous Tumors in the Long Bones

Classification of Chondrosarcoma: From Characteristic to Challenging Imaging Findings

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