A pragmatic approach to the imaging and follow-up of solitary central cartilage tumours of the proximal humerus and knee

Patel, A.; Davies, A. M.; Botchu, Rajesh; James, Steven

doi:10.1016/j.crad.2019.01.025

Cited by 33 publications

(20 citation statements)

References 46 publications

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“…Due to sparse knowledge on the biological behavior of these tumors, guidelines for active surveillance are lacking and follow-up strategies vary amongst institutions. The Birmingham study group developed a pragmatic imaging tool for triaging cases for referral [11]. We agree that the current rise in incidence of these tumors warrants a pragmatic approach, as a large prospective long term follow-up study would take too long to accomplish.…”

Section: Discussionmentioning

confidence: 91%

“…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%

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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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Section: Discussionmentioning

confidence: 91%

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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“…The remaining border-line cases, sometimes referred to as quiescent, will require some form of imaging followup usually with MRI although how often and for how long is contentious. 4,6,43e46 It is for this reason that the authors of this study have adopted an in-house protocol for the follow-up of CCTs in the proximal humerus and around the knee which attempts to be risk averse without a commitment to a never-ending cycle of MRI 7,8,47 similar to subsequently published Danish guidelines. 48 However, the threshold for follow-up imaging and biopsy of central and proximal femoral CCTs as stressed above needs to be lower as the risk of malignancy at these sites is higher.…”

Section: Discussionmentioning

confidence: 99%

“…2e6 Recent publications have highlighted that, in the context of multidisciplinary deliberations, what was an occasional academic exercise, has now become an all too regular occurrence in specialist orthopaedic oncology units. 7,8 This has been attributed largely to the increasing routine use of magnetic resonance imaging (MRI) 7,9 with CCTs identified in the proximal humerus in 2.1% 10 and around the knee in 2.8% 11,12 on routine MRI studies. The purpose of this retrospective study was to identify the change in referral incidence of central chondrosarcoma (CS) of bone treated in a single large specialist orthopaedic oncology centre over 33 years.…”

Section: Introductionmentioning

confidence: 99%

The changing face of central chondrosarcoma of bone. One UK-based orthopaedic oncology unit’s experience of 33 years referrals

Davies

Patel

Botchu

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Aim: To ascertain the changing incidence over time of the three commonest primary sarcomas of bone. Data obtained with particular reference to central chondrosarcoma from the annual referral rate to a large UK-based specialist orthopaedic oncology unit. To discuss how the "barnyard pen" analogy of cancers previously applied to certain commoner cancers can also be applicable to central chondrosarcoma (CS) of bone. Materials and methods: A retrospective review was conducted of a computerised database identifying all central cartilage tumours (CCT) of bone, including enchondroma and CS subtypes, between 1985 and 2018. These were compared with the referrals of the other two commonest primary sarcomas of bone, osteosarcoma and Ewing sarcoma. Results: There was a total of 1507 CS showing a 68% overall increase in annual referral rate/incidence over the study period. 68% cases were the borderline malignant lesions now known as atypical cartilaginous tumour (ACT). The annual referral rate/incidence of this entity increased by 194% over the 30 years. Whereas, the annual referral rate/incidence for osteosarcoma and Ewing sarcoma was static for the past 20 years. Conclusion:The annual incidence of central CS of bone showed a marked increase over the 33-year period as compared with both osteosarcoma and Ewing sarcoma. This is especially in the ACT category and is thought to be due to the increased provision of MRI scanning flagging up a rise in incidental findings. The spectrum of CCTs from benign to highly malignant elegantly fits the "barn yard" pen analogy and could prove useful as an explanatory tool for patients and clinicians unfamiliar with these diseases.

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“… 8 13 14 15 16 Recent studies have highlighted the increased identification of CCTs attributed to the ever-increasing use of MRI particularly in the proximal humerus and around the knee. 17 18 Guidelines and imaging protocols for the management and follow-up have been proposed in an attempt to reduce costly and in many instances diagnostically low-yield follow-up imaging studies. 9 11 19 20 21 Whether the enchondromas retrospectively identified in this study merited any follow-up is debatable as the three cases (33%) that did undergo a repeat MRI scan showed no change including one after 5 years ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Enchondromas of the Proximal Femur in Adults as an Incidental Finding on MRI of the Pelvis

Davies

Patel

Azzopardi

et al. 2021

Indian J Radiol Imaging

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Objective To determine the prevalence of enchondroma in adults as an incidental finding in the proximal femur on magnetic resonance imaging (MRI). Materials and Methods A retrospective review of the MRI scans of the pelvis in a series of adult patients was conducted. All presented with nononcological musculoskeletal complaints. The site, size, and appearances of the enchondromas were identified according to criteria from previous studies. Results A total of 1,209 proximal femora in 610 patients were reviewed and a total of 9 enchondromas were identified. These ranged from 0.6 to 2.5 cm in length (mean 1.3 cm). None showed aggressive features suggestive of malignancy. Three cases (33%) underwent follow-up MRI scans which showed no change in size or morphology. Conclusion The prevalence on MRI of incidental enchondromas arising in the proximal femur is 0.7%. This is three to four times less common than seen in the proximal humerus and around the knee.

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A pragmatic approach to the imaging and follow-up of solitary central cartilage tumours of the proximal humerus and knee

Cited by 33 publications

References 46 publications

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

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

The changing face of central chondrosarcoma of bone. One UK-based orthopaedic oncology unit’s experience of 33 years referrals

Prevalence of Enchondromas of the Proximal Femur in Adults as an Incidental Finding on MRI of the Pelvis

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