Preoperative CT for prediction of local recurrence after curettage of giant cell tumor of bone

Zhou, Lenian; Lin, Shanyi; Jin, Hanqiang; Zhang, Zhaoyuan; Zhang, Changqing; Yuan, Ting

doi:10.1016/j.jbo.2021.100366

Cited by 6 publications

(5 citation statements)

References 34 publications

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“…Recurrence or voluminous lesions could have the increased risk to develop pulmonary metastasis, for which wide resection and reconstruction are recommended [ 25 , 26 ]. GCTB of the wrist may have a poor prognosis compared with GCTB at other sites [ 6 , 16 ]. However, the prognostic results of different treatment procedures are unknown due to the rarity of distal ulna GCTB and lack of relevant studies [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

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Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study

Zhou,

Tang,

Shen

et al. 2023

J Orthop Surg Res

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Objective The wrist is the second most commonly involved location for GCTB, while distal ulna is a relatively rare location and limited evidence exists on which surgical approaches and reconstruction techniques are optimal. We carried out a multicenter retrospective study to evaluate the recurrence rate of distal ulna GCTB and the long-term functional outcomes of different surgery options. Methods All 28 patients received surgical treatment for distal ulna GCTB in one of three tertiary bone tumor centers between May 2007 and January 2021 with a minimum two-year follow-up. Surgical options included intralesional curettage or en bloc resection (one of 3 types). Functional outcomes were assessed by the MSTS score, the QuickDASH instrument, MWS, and MHQ according to the latest treatment. Results Overall recurrence rate was 14.2%. The curettage group (N = 7) had a significantly higher recurrence rate compared to en bloc resection (N = 21) (42.9% vs 4.8%) (mean follow-up: 88.8 mo). Seven patients received the Darrach procedure, 5 received the original Sauvé–Kapandji procedure, and 9 received the modified Sauvé–Kapandji procedure with extensor carpi ulnaris (ECU) tenodesis. Of the 4 patients having a recurrence, 1 received the Darrach EBR, 2 received the modified Sauvé–Kapandji procedure, and 1 received resection for soft tissue recurrence. Only MWS and esthetics in the MHQ scores were different (curettage, Darrach, Sauvé–Kapandji, and Sauvé–Kapandji with ECU tenodesis [MWS: 96.5 ± 1.3 vs 91.5 ± 4.7 vs 90.8 ± 2.8 vs 91.5 ± 3.6; esthetics in MHQ: 98.5 ± 3.1 vs 89.9 ± 4.7 vs 93.8 ± 4.4 vs 92.6 ± 3.8], respectively). Conclusions En bloc resection for distal ulna GCTB had a significantly lower recurrence rate compared with curettage and achieved favorable functional outcome scores. Given the higher recurrence rate after curettage, patients should be well informed of the potential benefits and risks of selecting the distal radioulnar joint-preserving procedure. Moreover, reconstructions after tumor resection of the ulna head do not appear to be necessary.

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Section: Discussionmentioning

confidence: 99%

“…Seven patients received extended intralesional curettage (Fig. 1 A, B) [ 16 ], 7 patients received the Darrach procedure (Fig. 1 C, D) [ 17 ], 5 patients received the original Sauvé–Kapandji procedure (Fig.…”

Section: Methodsmentioning

confidence: 99%

Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study

Zhou,

Tang,

Shen

et al. 2023

J Orthop Surg Res

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“…The result was reasonable because the risk factor of local recurrence for GCTB was intricate. Previous studies have found age [ 37 – 39 ], Campanacci classification [ 40 , 41 ], tumor sites [ 31 , 42 , 43 ], inflammation related factors [ 44 , 45 ], and image related factors [ 46 – 48 ] were potential risk factors of recurrence. Due to the exploratory nature of this study, the sample size of single tumor was relatively small and it was lack of including other more detailed and potential confounding factors, which had a certain impact on the analysis results.…”

Section: Discussionmentioning

confidence: 99%

The blood pressure and use of tourniquet are related to local recurrence after intralesional curettage of primary benign bone tumors: a retrospective and hypothesis-generating study

Zhou

Lin

Zhu

et al. 2022

BMC Musculoskelet Disord

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Aims Intralesional curettage is a commonly used treatment for primary bone tumors. However, local recurrence of tumors after curettage remains a major challenge. Questions (1) Is blood pressure related to local recurrence after intralesional curettage for benign or intermediate bone tumors? (2) What’s the impact of tourniquet usage on the risk of recurrence from high blood pressure? Methods This retrospective study evaluated patients receiving intralesional curettage for primary bone tumors from January 2011 to January 2015. A total of 411 patients with a minimum five-year follow-up were included for analysis. Demographic and disease-related variables were first assessed in univariable analyses for local recurrence risk. When a yielded p-value was < 0.2, variables were included in multivariable analyses to identify independent risk factors for local recurrence. Patients were then stratified by tourniquet usage (use/non-use), and risk from high blood pressure was evaluated in both subgroups. Results At an average follow-up of 6.8 ± 1.0 years, 63 of 411 patients (15.3%) experienced local recurrence. In multivariable analyses, local recurrence was associated with age (OR, 0.96; 95% CI, 0.94–0.99; p = 0.005); tumor type; lesion size (> 5 cm: OR, 3.58; 95% CI, 1.38–9.33; p = 0.009); anatomical site (proximal femur: OR, 2.49; 95% CI, 1.21–5.15; p = 0.014; proximal humerus: OR, 3.34; 95% CI, 1.61–6.92; p = 0.001); and preoperative mean arterial pressure (> 110 mmHg: OR, 2.61; 95% CI, 1.20–5.67; P = 0.015). In subgroup analyses, after adjusting for age, tumor type, lesion size, and anatomical site, tourniquet use modified the preoperative mean arterial pressure - recurrence relationship: when tourniquet was not used, preoperative mean arterial pressure predicted local recurrence (95–110 mmHg, 4.13, 1.42–12.03, p = 0.009; > 110 mmHg, 28.06, 5.27–149.30, p < 0.001); when tourniquet was used, preoperative mean arterial pressure was not related to local recurrence (all p values > 0.05). Conclusions A high preoperative blood pressure was related to local recurrence after intralesional curettage for primary bone tumors in our study. Tourniquet usage and controlling blood pressure might be beneficial for reducing local recurrence in patients scheduled to receive intralesional curettage for primary bone tumor treatment. Level of evidence Level IV, hypothesis-generating study.

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“…Zhou et al [ 89 ] systematically investigated the prognostic value of preoperative CT images in 211 patients subject to extended curettage for GCTB, measuring tumor size, distance between the tumor edge and articular surface, thickness of the thinnest part of the cortex affected by the tumor and thickness of unaffected bone cortex. Statistical analyses demonstrated that the distance from the tumor edge to the articular surface < 2 mm, thickness of unaffected cortical bone around the tumor < 3 mm and patient age at surgery were independent risk factors associated with GCTB recurrence ( p < 0.05, C-index 0.82 (CI, 0.76 to 0.88)).…”

Section: Imaging Contribution In Gctb Managementmentioning

confidence: 99%

State of the Art and New Concepts in Giant Cell Tumor of Bone: Imaging Features and Tumor Characteristics

Parmeggiani

Miceli

Errani

et al. 2021

Cancers

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Giant cell tumor of bone (GCTB) is classified as an intermediate malignant tumor due to its locally aggressive behavior, burdened by high local recurrence rate. GCTB accounts for about 4–5% of all primary bone tumors and typically arises in the metaphysis and epiphyses of the long tubular bones. Mutation of gene H3F3A is at the basis of GCTB etiopathogenesis, and its immunohistochemical expression is a valuable method for practical diagnosis, even if new biomarkers have been identified for early diagnosis and for potential tumor recurrence prediction. In the era of computer-aided diagnosis, imaging plays a key role in the assessment of GCTB for surgical planning, patients’ prognosis prediction and post treatment evaluation. Cystic changes, penetrating irregular margins and adjacent soft tissue invasion on preoperative Magnetic Resonance Imaging (MRI) have been associated with a higher rate of local recurrence. Distance from the tumor edge to the articular surface and thickness of unaffected cortical bone around the tumor should be evaluated on Computed Tomography (CT) as related to local recurrence. Main features associated with local recurrence after curettage are bone resorption around the graft or cement, soft tissue mass formation and expansile destruction of bone. A denosumab positive response is represented by a peripherical well-defined osteosclerosis around the lesion and intralesional ossification. Radiomics has proved to offer a valuable contribution in aiding GCTB pre-operative diagnosis through clinical-radiomics models based on CT scans and multiparametric MR imaging, possibly guiding the choice of a patient-tailored treatment. Moreover, radiomics models based on texture analysis demonstrated to be a promising alternative solution for the assessment of GCTB response to denosumab both on conventional radiography and CT since the quantitative variation of some radiomics features after therapy has been correlated with tumor response, suggesting they might facilitate disease monitoring during post-denosumab surveillance.

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Preoperative CT for prediction of local recurrence after curettage of giant cell tumor of bone

Abstract: Highlights Preoperative CT images of GCTBs have value in prognostic prediction. Certain features of GCTBs on CT images are related to local recurrence. Our models’ predictions for GCTB patients accepting extensive curettage are good.

Cited by 6 publications

References 34 publications

Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study

Giant cell tumors of the distal ulna: long-term recurrence rate and functional outcomes of en bloc resection versus curettage in a multicenter study

The blood pressure and use of tourniquet are related to local recurrence after intralesional curettage of primary benign bone tumors: a retrospective and hypothesis-generating study

State of the Art and New Concepts in Giant Cell Tumor of Bone: Imaging Features and Tumor Characteristics

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