Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Galsterer, S.
Enchondroma vs. Chondrosarcoma G1: Which features indicate malignancy?
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 109
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leithner Andreas
- Smolle Maria Anna
- Altmetrics:
- Abstract:
- Objective Differentiating between enchondroma (EC) and atypical cartilaginous tumour (ACT) on a radiologic basis can be very challenging. It is often not clear if the tumour is benign or malignant, but if known, surgery or biopsy may not be required. Our aim is to identify specific features which indicate malignancy both radiologically and clinically to get an overall impression. Materials and methods All patients with histologically verified diagnosis “enchondroma” or “atypical cartilaginous tumour” – former chondrosarcoma (CS) G1 – of the long bones between 2006 and 2018 at one institution were retrospectively included. Data was collected from MEDOCS, included personal data, symptoms, diagnostic findings, x-ray, magnetic resonance imaging (MRI) and computed tomography (CT) images, scintigraphy, histological results, follow-up and relapses. 103 x-rays and 25 MRIs were subsequently blindly re-evaluated by two radiologists and two orthopaedic surgeons from the Medical University of Graz, regarding radiological features like cortex-arrosion and peritumoral oedema. Afterwards a diagnosis based on these features was made, separately for x-ray and MRI. A fifth reviewer diagnosed lesions on x-rays only. Afterwards, a debriefing was performed to check the final diagnosis. Some diagnoses were subsequently changed adhering to current guidelines. Results Cortex-arrosion was the only significant radiological feature to differentiate between EC and ACT/CS G1. There was also a significant difference regarding size between the two tumour entities. The intraclass correlation coefficient was rather poor for most of the features, indicating a high interobserver variability. Only the features “tumour location” (x-ray and MRI) and “cortex-arrosion” (x-ray) showed a good or excellent agreement. The diagnosis made by the reviewers based on x-ray and MRI correlated with the histopathological one in 65.9% (5 reviewers) and 66.7% (4 reviewers). Sensitivity on x-ray and on MRI was 83.1% and 89.3%, respectively, and the specificity 29.7% (x-ray) and 28.0% (MRI). Conclusion Distinguishing between ECs and ACTs/CSs G1 still remains challenging in case only imaging is used. One of the major problems is the high interobserver variability, wherefore radiology only may not lead to the correct diagnosis of EC and ACT/CS G1. Consequently, the importance of a multidisciplinary approach involving clinical presentation, radiology and histology is highlighted.