Enchondroma versus low grade cchondrosarcoma in the appendicular skeleton: Clinical-radiological criteria

Abstract

Objectives To determine the validity of the clinical-radiological characteristics with the biopsy, and contrast the biopsy results with the clinical diagnosis based on the history and radiological tests. Material and method The study included 96 patients with cartilage type lesions suggestive of an enchondroma (E) or a low grade chondrosarcoma (LGC) according to the clinical and X-ray data, the anamnesis, physical examination, simple X-ray, computerised tomography (CT), nuclear magnetic resonance (MRI) and a Technetium-99 bone scan of the whole skeleton. The hypotheses were contrasted with the histopathological diagnosis of enchondroma or low grade chondrosarcoma. Results Of the 82 patients studied completely, 56 were considered enchondromas (68.29%), 8 as chondrosarcomas (8.33%) and in 18 (18.75%) a definitive diagnosis could not be made and were considered as suspected LGC. Of these, the biopsy showed 3 enchondromas (25%), 9 LGC (50%) and 3 were not definitive (and were treated as LGC). On the other hand, of the 56 cases diagnosed as enchondromas, 15 were biopsied, with 5 of them being diagnosed as LGC (33.3%). The 8 cases diagnosed as LGC, were also biopsied and only 4 biopsies (50%) confirmed the initial diagnosis. None of the clinical-radiological characteristics study showed any statistically significant differences that would enable them to be associated with an E or an LGC. Likewise, the correlation analysis between the diagnosis issued initially and the biopsy result gave a value of 0.69 (kappa coefficient), which was considered a good correlation. Conclusion The clinical-radiological diagnosis inferred from the clinical picture and the imaging test did not have definitive validity when deciding on simple observation or biopsy and treatment in these patients.