Can imaging criteria distinguish enchondroma from grade 1 chondrosarcoma?

Crim, Julia R.; Schmidt, Robert L.; Layfield, Lester J.; Hanrahan, Christopher J.; Manaster, B.J.

doi:10.1016/j.ejrad.2015.06.033

Cited by 86 publications

(90 citation statements)

References 28 publications

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“…3), and this assumption was supported by the finding of lower agreement in the diagnosis of low-grade malignant cartilaginous neoplasms in our study. This result is probably attributable to the limited discriminating power of many of the commonly used imaging parameters, such as cortical compromise, periosteal reaction, tumor diameter, and soft tissue extension [2,3,21,31].…”

Section: Discussionmentioning

confidence: 97%

“…Other studies have shown that the ability to diagnose cartilaginous neoplasms is improved by using a combination of imaging modalities, especially the combination of radiographs and MRI, even when increased false positive and false negative findings were observed for the latter [2,4]. Crim et al [2] found low interobserver agreement for evaluation of individual imaging criteria and for expert diagnosis based on the results of a single image modality, supporting the need for a multimodality imaging approach.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, only five of 39 patients with full agreement on their diagnosis is extremely low. Interobserver evaluations have shown variable agreement for the diagnosis of these types of lesions by other specialists, with j values of 0.19 to 0.36 for experienced radiologists [2,12,27] and 0.44 to 0.78 for pathologists [6,27]. The benign intramedullary variant of this neoplasm class, enchondroma, is usually asymptomatic and can be treated with observation alone to rule out progression [14].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, no specific gold standard has been developed to resolve this diagnostic challenge. Advanced imaging has been of great aid performing these diagnoses, but radiography, CT, and MRI have limitations [2,4]. In addition, even pathologists have difficulties establishing these diagnoses [27], with a lower than an desirable agreement between experts.…”

Section: Introductionmentioning

confidence: 99%

“…Questions/Purposes (1) to determine inter-and intraobserver agreement among a multinational panel of expert orthopaedic oncologists in diagnosing cartilaginous neoplasms based on their assessment of clinical symptoms and imaging at diagnosis. (2) To describe the most important clinical and imaging features that experts use during the initial diagnostic process. (3) To determine interobserver agreement for proposed initial treatment strategies for cartilaginous neoplasms by this panel of evaluators.…”

Section: Introductionmentioning

confidence: 99%

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Do Orthopaedic Oncologists Agree on the Diagnosis and Treatment of Cartilage Tumors of the Appendicular Skeleton?

Zamora

Urrutia

Schweitzer

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Distinguishing a benign enchondroma from a low-grade chondrosarcoma is a common diagnostic challenge for orthopaedic oncologists. Low interrater agreement has been observed for the diagnosis of cartilaginous neoplasms among radiologists and pathologists, but, to our knowledge, no study has evaluated inter-and intraobserver agreement among orthopaedic oncologists grading these lesions using initial clinical and imaging information. Determining such agreement is important since it reflects the certainty in the diagnosis by orthopaedic oncologists. Agreement also is important as it will guide future treatment and prognosis, considering that there is no gold standard for diagnosis of these lesions. Questions/Purposes (1) to determine inter-and intraobserver agreement among a multinational panel of expert orthopaedic oncologists in diagnosing cartilaginous neoplasms based on their assessment of clinical symptoms and imaging at diagnosis. (2) To describe the most important clinical and imaging features that experts use during the initial diagnostic process. (3) To determine interobserver agreement for proposed initial treatment strategies for cartilaginous neoplasms by this panel of evaluators. Methods Thirty-nine patients with intramedullary cartilaginous neoplasms of the appendicular skeleton of various histopathologic grades were selected and classified as having benign, low-grade malignant, or intermediate-or high-grade malignant neoplasms by 10 experienced orthopaedic oncologists based on clinical and imaging information. Additionally, they chose the three most important clinical or imaging features for the diagnosis of these neoplasms, and they proposed a treatment strategy for each patient. The Kappa coefficient (j) was used to determine inter-and intraobserver agreement. Results Inter-and intraobserver agreements were only fair to good, j = 0.44(95% CI, 0.41-0.48) and j = 0.62 (95% CI, 0.52-0.72), respectively. The three factors most frequently identified as helpful in making the diagnosis by our panel were cortical involvement in 65% of evaluations (253/390), neoplasm size in 51% (198/390), and pain in 50% (194/390). The interobserver agreement for the proposed initial treatment strategy after diagnosis was poor (j = 0.21; 95% CI, 0.18-0.24). Conclusions This study showed barely fair interobserver and fair to good intraobserver agreement for grading of intramedullary cartilaginous neoplasms by orthopaedic oncologists using initial clinical and imaging findings. These results reflect the insufficient guidance interpreting clinical and imaging features, and the limitations of the systems we use today when making these diagnoses. In the same way, they generate concern for the implications that this may have on different treatment strategies and the future prognosis of our patients. Future studies should build

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Do Orthopaedic Oncologists Agree on the Diagnosis and Treatment of Cartilage Tumors of the Appendicular Skeleton?

Zamora

Urrutia

Schweitzer

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Bone Tumors

Damron¹

2022

Holland‐Frei Cancer Medicine

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Overview As a group, bone tumors are uncommon lesions arising from a wide array of cells, affecting all ages of patients, and involving any bone in the body. Benign bone lesions are quite common and range from inactive to active and aggressive tumors. Treatment of inactive bone lesions is most often observation. Active benign bone lesions are frequently treated surgically by curettage. Benign aggressive tumors often require extended intralesional curettage with adjuncts. Among malignant bone lesions, the most common bone malignancy is metastatic carcinoma, and the most common primary bone malignancy is myeloma. The focus on bone involvement in these tumors is fixation of pathologic fractures and prediction of impending fractures. Primary bone sarcomas are rare tumors with characteristic clinical, radiographic, and pathologic features. Treatment of bone sarcomas most often requires wide surgical resection with or without chemotherapy and/or radiotherapy. Although often numerous specialties may contribute to their evaluation and care, orthopedic oncology is the only subspecialty focused specifically on all aspects of bone tumors.

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