The safety of direct primary excision of low-grade chondral lesions based on radiological diagnosis alone.
The safety of treating low-grade chondral tumours by primary surgery without a pre- operative diagnostic needle biopsy was assessed by looking at the concordance between radiological and histological diagnoses. A retrospective review of the departmental histopathology registry from 2005 to 2009 was performed to identify cases of intramedullary chondral lesions in the appendicular skeleton. Cases with a pre-operative needle biopsy and with recurrence were excluded. Correlation between radiological and histological diagnosis was investigated with kappa analysis. Of 53 patients, bone expansion was seen in 18.4%, endosteal scalloping in 42.9% and extraosseous extension in 143%. Concordance was 100% between the radiological and histological diagnoses (Kappa score = 1.0). If a radiological diagnosis of an enchondroma or low-grade chondrosarcoma is made, then direct surgical treatment without needle biopsy is safe. A biopsy should be considered if any atypical radiological features suggesting a high-grade chondrosarcoma exist. This increases the certainty of diagnosis and allows planning of surgical treatment.
Royal National Orthopaedic Hospital, Sarcoma Unit, Brockley Hill, Stanmore, Middlesex HA74LP, UK. oberber@gmail.com
Onur
O
Berber
Gorav
G
Datta
Sanjeeve
S
Sabharwal
Will
W
Aston
Asif
A
Saifuddin
Tim
T
Briggs
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002648:Child; D002812:Chondroma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002813:Chondrosarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult