Abstract
Simple SummaryBackground: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. Methods: To evaluate the diagnostic usefulness of radiological findings for differentiation between enchondromas and chondrosarcomas, correlations between various radiological findings and final diagnoses were investigated. Based on the correlations, a scoring system combining these findings was developed. Results: In a cohort of 81 patients, periosteal reaction on X-ray, endosteal scalloping and cortical defect on CT, extraskeletal mass, multilobular lesion, abnormal signal in adjacent tissue on MRI, and increased uptake in bone scan and thallium scan was significantly correlated with final diagnoses. Based on the correlations, a radiological scoring system combining radiological findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and chondrosarcomas were 88%, 89%, and 88%, respectively. Conclusion: Comprehensive assessment combining radiological findings is recommended to differentiate between enchondromas and ACTs/chondrosarcomas.Background: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. In this study, correlations between radiological findings and final diagnosis were investigated in patients with central cartilaginous tumors. Methods: To evaluate the diagnostic usefulness of radiological findings, correlations between various radiological findings and final diagnoses were investigated in a cohort of 81 patients. Furthermore, a new radiological scoring system was developed by combining radiological findings. Results: Periosteal reaction on X-ray (p = 0.025), endosteal scalloping (p = 0.010) and cortical defect (p = 0.002) on CT, extraskeletal mass (p < 0.001), multilobular lesion (p < 0.001), abnormal signal in adjacent tissue (p = 0.004) on MRI, and increased uptake in bone scan (p = 0.002) and thallium scan (p = 0.027) was significantly correlated with final diagnoses. Based on the correlations between each radiological finding and postoperative histological diagnosis, a radiological scoring system combining these findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and ACTs/chondrosarcomas were 88%, 89%, and 88%, respectively (p = 0.003). Conclusion: Radiological assessment with combined radiological findings is recommended to differentiate between enchondromas and ACT/chondrosarcomas.
Highlights
Cartilaginous tumors, which are characterized by the formation of a cartilaginous matrix, are one of the most common bone tumors [1]
To diagnose atypical cartilaginous tumors (ACTs)/chondrosarcoma, sensitivity, specificity, and accuracy were 12.1%, 100.0%, and 64.2% for periosteal reaction on X-ray (K = 0.141); 96.7%, 29.6%, and 64.9% for endosteal scalloping on computed tomography (CT) (K = 0.272); 86.7%, 55.6%, and 71.9% for cortical defect on CT (K = 0.429); 61.3%, 100.0%, and 82.9% for extraskeletal mass on magnetic resonance imaging (MRI) (K = 0.638); 80.6%, 92.3%, and 87.1% for multilobular lesion on MRI (K = 0.737); 32.3%, 94.9%, and 67.1% for abnormal signal in adjacent bone marrow and soft tissue on MRI (K = 0.289); 100.0%, 41.7%, and 80.6% for increased uptake on bone scan (K = 0.488); and 45.0%, 100.0%, and 62.1% for increased uptake on 201Tl scan (K = 0.337), respectively (Table 3)
Based on the K values of the radiological findings for differentiation between enchondroma and ACTs/chondrosarcoma, 3 points were attached to the extraskeletal mass on MRI and multilobular lesion on MRI; 2 points were attached to cortical defect on CT, and abnormal signal in the adjacent bone marrow and soft tissue on MRI, increased uptake on bone scan, and increased uptake on 201Tl scan; and 1 point was attached to the periosteal reaction in the X-ray and endosteal scalloping on CT (Table 4)
Summary
Cartilaginous tumors, which are characterized by the formation of a cartilaginous matrix, are one of the most common bone tumors [1]. A new method is needed for distinguishing between enchondromas and ACT/chondrosarcomas to aid in the definitive diagnosis of cartilaginous tumors. Correlations between radiological findings and final diagnosis were investigated in patients with central cartilaginous tumors. Methods: To evaluate the diagnostic usefulness of radiological findings, correlations between various radiological findings and final diagnoses were investigated in a cohort of 81 patients. Based on the correlations between each radiological finding and postoperative histological diagnosis, a radiological scoring system combining these findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and ACTs/chondrosarcomas were 88%, 89%, and 88%, respectively (p = 0.003). Conclusion: Radiological assessment with combined radiological findings is recommended to differentiate between enchondromas and ACT/chondrosarcomas
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