Abstract
IntroductionHeterogeneity of cartilage tumours may confound accurate diagnosis and grading resulting in under and over treatment. Improved preoperative assessment of malignancy and grade would be invaluable for developing a rational plan for treatment. We examined correlations between nuclear tracer avidity and malignancy grade in cartilage tumours.MethodsBetween 1996 and 2000, 92 consecutive patients with cartilaginous tumours (50 benign, 42 non-metastatic malignant) underwent nuclear scanning. Thallium-201 (TL-201) and pentavalent dimercaptosuccinic acid (DMSAV) were used as nuclear isotopes. Scanning with these agents was performed on separate days 48 hours apart. Static and SPECT images were obtained at 30 m and 4 h after injection of nuclear tracer. Pathology review was undertaken blinded to the results of the nuclear scans and correlations between histologic results and trace uptake at 4 hours examined.Results25 patients with negative DMSAV had benign tumours. 15/17 tumours with positive TL-201 had malignant tumours. 11/13 patients with both positive DMSAV and TL-201 scans had intermediate or high grade tumours and 4 of these developed metastases. We have developed an algorithm for the management of patients with tumours that aims to avoid over treatment of low grade tumours and under treatment of high grade tumours.ConclusionFunctional nuclear scanning with TL-201 and DMSAV complements other imaging modalities in the management of cartilaginous tumours.
Highlights
Heterogeneity of cartilage tumours may confound accurate diagnosis and grading resulting in under and over treatment
Given that malignant tumours are more metabolically active than benign tumours, and that there is a relationship between grade of malignancy and metabolic activity, functional nuclear scans may help to differentiate between cartilage tumours of varying metabolic activity, which in turn, may shed some light on their state of malignancy
We report our experiences with 2 radio-siotopes, Thallium-201 (Tl-201) and pentavalent dimercaptosuccinic acid (DMSAV) for determining the metabolic activity of cartilage tumours, and their value in differentiating between malignant and benign cartilage tumours in 92 consecutive cartilage tumours
Summary
Heterogeneity of cartilage tumours may confound accurate diagnosis and grading resulting in under and over treatment. While the recognition of high grade malignancy is not difficult, the differentiation between benign and low grade (grade I) tumours can present a diagnostic dilemma [10,11]. Such a dilemma may lead inadvertently to under-or over-treatment of cartilage tumours. Given that malignant tumours are more metabolically active than benign tumours, and that there is a relationship between grade of malignancy and metabolic activity, functional nuclear scans may help to differentiate between cartilage tumours of varying metabolic activity, which in turn, may shed some light on their state of malignancy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
