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Radiological and histopathological assessment of bone infiltration in soft tissue sarcomas

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Deep soft tissue sarcomas are frequently in contact with bone. The therapeutic decision of a composite resection strategy may be challenging, which is usually based on clinical and radiological criteria. The aims of the study were to evaluate the overall frequency of bone and periosteal infiltration in these patients in whom composite resection was indicated, and evaluate the role of magnetic resonance imaging and bone scintigraphy in this scenario.

Methods

Forty-nine patients with a composite surgical resection (soft tissue sarcoma and bone), treated at a single institution between 2006 and 2018, were retrospectively included. Presurgical planning of the resection limits was based on clinical and imaging findings (magnetic resonance imaging and bone scintigraphy). Magnetic resonance imaging was performed in all patients (100%) and bone scintigraphy in 41 (83.7% of the cases). According to magnetic resonance imaging results, patients were divided into two groups: Group A, in which the tumor is adjacent to the bone without evidence of infiltration (n = 24, 48,9%), and Group B, patients with evidence of bone involvement by magnetic resonance imaging (n = 25, 51,1%). BS showed a pathological deposit in 28 patients (68.3%). Histological analysis of the resection specimen was preceded to identify bone and periosteal infiltration. For the analysis of the diagnostic validity of imaging tests, histological diagnosis was considered as the gold standard in the evaluation of STS bone infiltration.

Results

Histological bone infiltration was identified in 49% of patients and isolated periosteal infiltration in 14.3%. In terms of diagnostic accuracy, magnetic resonance imaging and bone scintigraphy sensitivity values were 92% and 90%, and their specificity values were 91.7% and 52.4%, respectively.

Conclusions

The incidence of bone and periosteal infiltration of soft tissue sarcomas in contact with bone is high. Presurgical bone assessment by MRI has proven to be a sensitive and specific tool in the diagnosis of bone infiltration. Due to its high negative predictive value, BS is a useful test to rule out it. In those cases, in which there is suspicion of bone infiltration not confirmed by MRI, new diagnostic protocols should be established in order to avoid inappropriate resections.

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References

  1. Ahmad R, Jacobson A, Hornicek F, Haynes AB, Choy E, Cote G, Nielsen GP, Chen YL, DeLaney TF, Mullen JT (2016) The width of the surgical margin does not influence outcomes in extremity and truncal soft tissue sarcoma treated with radiotherapy. Oncologist 21(10):1269–1276. https://doi.org/10.1634/theoncologist.2015-0534

    Article  PubMed  PubMed Central  Google Scholar 

  2. Harati K, Goertz O, Pieper A, Daigeler A, Joneidi-Jafari H, Niggemann H, Stricker I, Lehnhardt M (2017) Soft tissue sarcomas of the extremities: surgical margins can be close as long as the resected tumor has no Ink on It. Oncol 22(11):1400–1410. https://doi.org/10.1634/theoncologist.2016-0498

    Article  Google Scholar 

  3. Kandel R, Coakley N, Werier J, Engel J, Ghert M, Verma S, Sarcoma Disease site group of cancer care ontario’s program in evidence-based care (2013) Surgical margins and handling of soft-tissue sarcoma in extremities: a clinical practice guideline. Curr Oncol 20(3):e247–54

  4. Endo M, Lin PP (2018) Surgical margins in the management of extremity soft tissue sarcoma. Chin Clin Oncol 7(4):37. https://doi.org/10.21037/cco.2018.08.10

    Article  PubMed  Google Scholar 

  5. Ferguson PC, Griffin AM, O’Sullivan B, Catton CN, Davis AM, Murri A, Bell RS, Wunder JS (2006) Bone invasion in extremity soft-tissue sarcoma: impact on disease outcomes. Cancer 106(12):2692–2700. https://doi.org/10.1002/cncr.21949

    Article  PubMed  Google Scholar 

  6. Gronchi A, Lo Vullo S, Colombo C, Collini P, Stacchiotti S, Mariani L, Fiore M, Casali PG (2010) Extremity soft tissue sarcoma in a series of patients treated at a single institution: local control directly impacts survival. Ann Surg 251(3):506–511. https://doi.org/10.1097/SLA.0b013e3181cf87fa

    Article  PubMed  Google Scholar 

  7. Panicek DM, Go SD, Healey JH, Leung DH, Brennan MF, Lewis JJ (1997) Soft-tissue sarcoma involving bone or neurovascular structures: MR imaging prognostic factors. Radiol 205(3):871–875

    Article  CAS  Google Scholar 

  8. Lin PP, Diaz E, Normand AN, Deavers MT, Cannon CP, Ballo MT, Pisters PW, Pollock RE, Lewis VO, Zagars GK, Yasko AW (2007) Periosteal Margin in Soft-Tissue Sarcoma. Cancer 109(3):598–602. https://doi.org/10.1002/cncr.22429

    Article  PubMed  Google Scholar 

  9. Amin MB, Edge S, Greene et al (2018) AJCC cancer staging manual, 8th edn. Springer International Publishing

  10. Stefanovski PD, Bidoli E, De Paoli A et al (2002) Prognostic factors in soft tissue sarcomas: a study of 395 patients. Eur J Surg Oncol 28:153–164. https://doi.org/10.1053/ejso.2001.1242

    Article  CAS  PubMed  Google Scholar 

  11. Stojadinovic A, Leung DH, Hoos A, Jaques DP, Lewis JJ, Brennan MF (2002) Analysis of the prognostic significance of microscopic margins in 2,084 localized primary adult soft tissue sarcomas. Ann Surg 235:424–434. https://doi.org/10.1097/00000658-200203000-00015

    Article  PubMed  PubMed Central  Google Scholar 

  12. Williard WC, Hajdu SI, Casper ES, Brennan MF (1992) Comparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity. Ann Surg 215:269–275. https://doi.org/10.1097/00000658-199203000-00012

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. White LM, Wunder JS, Bell RS et al (2005) Histologic assessment of peritumoral edema in soft tissue sarcoma. Int J Radiat Oncol Biol Phys 61:1439–1445. https://doi.org/10.1016/j.ijrobp.2004.08.036

    Article  PubMed  Google Scholar 

  14. Kransdorf MJ, Murphey MD (1997) The use of gadolinium in the MR evaluation of soft tissue tumors. Semin Ultrasound CT MR 18:251–268. https://doi.org/10.1016/s0887-2171(97)80016-9

    Article  CAS  PubMed  Google Scholar 

  15. Berthoty D, Haghighi P, Sartoris DJ, Resnick D (1989) Osseous invasion by soft-tissue sarcoma seen better on MR than on CT (letter). AJR Am J Roentgenol 152:113. https://doi.org/10.2214/ajr.152.5.1131-a

    Article  Google Scholar 

  16. Elias DA, White LM, Simpson DJ, Kandel RA, Tomlinson G, Bell RS, Wunder JS (2003 Oct) Osseous invasion by soft-tissue sarcoma: assessment with MR imaging. Radiology 229(1):145–152. https://doi.org/10.1148/radiol.2291020377

    Article  PubMed  Google Scholar 

  17. Panicek DM, Gatsonis C, Rosenthal DI et al (1997) CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms: report of the Radiology Diagnostic Oncology Group. Radiology 202:237–246. https://doi.org/10.1148/radiology.202.1.8988217

    Article  CAS  PubMed  Google Scholar 

  18. Richardson ML, Zink-Brody GC, Patten RM, Koh WJ, Conrad EU (1996) MR characterization of post-irradiation soft tissue edema. Skeletal Radiol 25:537–543. https://doi.org/10.1007/s002560050131

    Article  CAS  PubMed  Google Scholar 

  19. Preidler KW, Brossmann J, Daenen B et al (1997) Measurements of cortical thickness in experimentally created endosteal bone lesions: a comparison of radiography, CT, MR imaging, and anatomic sections. AJR Am J Roentgenol 168:1501–1505. https://doi.org/10.2214/ajr.168.6.9168714

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Oncology Unit, “Doce de Octubre” University Hospital, Avda. De Córdoba s/n, 28041, Madrid, Spain

    Luis Rodrigo Merino-Rueda

  2. Orthopaedic Oncology Unit, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain

    Luis Rodrigo Merino-Rueda, Irene Barrientos-Ruiz, Manuel Peleteiro-Pensado & Eduardo J. Ortiz-Cruz

  3. Radiology Department, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain

    Daniel Bernabeu-Taboada

  4. Pathology Department, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain

    José J. Pozo-Kreilinger

  5. Nuclear Medicine Department, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain

    José M. Cordero-García

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  1. Luis Rodrigo Merino-Rueda
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Correspondence to Luis Rodrigo Merino-Rueda.

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Merino-Rueda, . ., Barrientos-Ruiz, I., Bernabeu-Taboada, D. et al. Radiological and histopathological assessment of bone infiltration in soft tissue sarcomas. Eur J Orthop Surg Traumatol 32, 631–639 (2022). https://doi.org/10.1007/s00590-021-03018-9

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  • DOI: https://doi.org/10.1007/s00590-021-03018-9

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