title: How safe is curettage of low-grade cartilaginous neoplasms diagnosed by imaging with or without pre-operative needle biopsy?
abstract: The pre-operative differentiation between enchondroma, low-grade chondrosarcoma and high-grade chondrosarcoma remains a diagnostic challenge. We reviewed the accuracy and safety of the radiological grading of cartilaginous tumours through the assessment of, first, pre-operative radiological and post-operative histological agreement, and second the rate of recurrence in lesions confirmed as high-grade on histology. We performed a retrospective review of major long bone cartilaginous tumours managed by curettage as low grade between 2001 and 2012. A total of 53 patients with a mean age of 47.6 years (8 to 71) were included. There were 23 men and 30 women. The tumours involved the femur (n = 20), humerus (n = 18), tibia (n = 9), fibula (n = 3), radius (n = 2) and ulna (n = 1). Pre-operative diagnoses resulted from multidisciplinary consensus following radiological review alone for 35 tumours, or with the addition of pre-operative image guided needle biopsy for 18. The histologically confirmed diagnosis was enchondroma for two (3.7%), low-grade chondrosarcoma for 49 (92.6%) and high-grade chondrosarcoma for two (3.7%). Three patients with a low-grade tumour developed a local recurrence at a mean of 15 months (12 to 17) post-operatively. A single high-grade recurrence (grade II) was treated with tibial diaphyseal replacement. The overall recurrence rate was 7.5% at a mean follow-up of 4.7 years (1.2 to 12.3). Cartilaginous tumours identified as low-grade on pre-operative imaging with or without additional image-guided needle biopsy can safely be managed as low-grade without pre-operative histological diagnosis. A few tumours may demonstrate high-grade features histologically, but the rates of recurrence are not affected.
authors.affiliation: Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: M T
authors.initials: MT
authors.lastname: Brown
authors.affiliation: Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: P D
authors.initials: PD
authors.lastname: Gikas
authors.affiliation: Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Bhamra
authors.affiliation: Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Skinner
authors.affiliation: Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: W J S
authors.initials: WJ
authors.lastname: Aston
authors.affiliation: Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: R C
authors.initials: RC
authors.lastname: Pollock
authors.affiliation: Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: A
authors.initials: A
authors.lastname: Saifuddin
authors.affiliation: Royal National Orthopaedic Hospital, London Bone and Soft Tissue Sarcoma Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: T W R
authors.initials: TW
authors.lastname: Briggs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000175:diagnosis / Q000601:surgery*; D002357:Cartilage Diseases / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002812:Chondroma / Q000175:diagnosis / Q000601:surgery*; D002813:Chondrosarcoma / Q000175:diagnosis / Q000601:surgery*; D003475:Curettage / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chondrosarcoma; Enchondroma; Imaging treatment; Low-grade Curettage