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The value of chest and skeletal staging in parosteal osteosarcoma: two-centre experience and literature review

Abstract

Objective

To determine the value of chest and skeletal staging in patients with parosteal osteosarcoma (POS), and the incidence of late local and chest recurrence.

Materials and methods

Retrospective review of patients across two institutions with histological confirmation of POS diagnosed between January 2007 and March 2020. Data collected included age, sex, skeletal location, results of chest CT and whole-body bone scintigraphy (WB-BSc) or whole-body MRI (WB-MRI) obtained at initial diagnosis. The histological tumour grade based on surgical resection specimens was classified as low-grade POS (LG-POS) and dedifferentiated POS (DD-POS). Findings of chest CT and skeletal staging were correlated with tumour grade. Follow-up chest CT and MRI studies were reviewed to determine the rate of late lung metastases and local recurrence.

Results

There were 27 males and 44 females, mean age 33 years (range 12–79 years). The femur (n = 43) and tibia (n = 14) were the most commonly involved bones. From surgical resection histology, 42 (59.2%) were LG-POS and 29 (40.8%) were DD-POS. WB-BSc/WB-MRI showed no skeletal metastases, while 1 case of DD-POS presented with bilateral calcified lung metastases. At follow-up, 7 patients (9.9%) developed lung metastases (mean of 18.9 months, range 10–48 months) from initial presentation, of which all were DD-POS. All but 1 patient who developed subsequent lung metastases had a local recurrence.

Conclusions

Skeletal staging is unlikely to be of value in POS. Staging chest CT is very unlikely to demonstrate lung metastases in LG-POS and could be limited to DD-POS, particularly at the time of local recurrence.

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References

  1. 1.

    Klein MJ, Siegal GP. Osteosarcoma: anatomic and histologic variants. Am J Clin Pathol. 2006;125(4):555–81.

    Article  Google Scholar 

  2. 2.

    Misaghi A, Goldin A, Awad M, Kulidjian AA. Osteosarcoma: a comprehensive review. SICOT J. 2018;4:12.

    Article  Google Scholar 

  3. 3.

    Hang JF, Chen PC. Parosteal osteosarcoma. Arch Pathol Lab Med. 2014 May;138(5):694–9.

    Article  Google Scholar 

  4. 4.

    Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. WHO classification of tumours of soft tissue and bone. 4th ed. Lyon, France: IARC Press; 2013.

    Google Scholar 

  5. 5.

    Miller BJ, Cram P, Lynch CF, Buckwalter JA. Risk factors for metastatic disease at presentation with osteosarcoma: an analysis of the SEER database. J Bone Joint Surg Am. 2013;95(13):e89.

    Article  Google Scholar 

  6. 6.

    Gerrand C, Athanasou N, Brennan B, et al. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res BioMed Central. 2016;6(1):7.

    Article  Google Scholar 

  7. 7.

    Casali PG, Bielack S, Abecassis N et al. Bone sarcomas: ESMO-PaedCan-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct;29 Suppl 4:iv79-iv95.

  8. 8.

    Bertoni F, Bacchini P, Staals EL, et al. Dedifferentiated parosteal osteosarcoma: the experience of the Rizzoli Institute. Cancer. 2005;103(11):2373–82.

    Article  Google Scholar 

  9. 9.

    Jelinek JS, Murphey MD, Kransdorf MJ, et al. Parosteal osteosarcoma: value of MR imaging and CT in the prediction of histologic grade. Radiology. 1996;201:837–42.

    CAS  Article  Google Scholar 

  10. 10.

    Okada F, Frassica FJ, Sim FH, et al. Parosteal osteosarcoma: a clinicopathological study. J Bone Joint Surg Am. 1994;76(3):366–78.

    CAS  Article  Google Scholar 

  11. 11.

    Cassone AEm Camargo OP, Croci AT, et al. Paraosteal osteosarcoma. Rev Bras Ortop. 1998; 33 (11).

  12. 12.

    Unni KK, Dahlin DC, Beabout JW, et al. Parosteal osteogenic sarcoma. Cancer. 1976;37:2466–75.

    CAS  Article  Google Scholar 

  13. 13.

    Hoshi M, Matsumoto S, Manabe J. Oncologic outcome of parosteal osteosarcoma. Int J Clin Oncol. 2006;11(2):120–6.

    Article  Google Scholar 

  14. 14.

    Lin HY, Hondar Wu HT, Wu PK, et al. Can imaging distinguish between low-grade and dedifferentiated parosteal osteosarcoma? J Chin Med Assoc. 2018;81(10):912–9.

    Article  Google Scholar 

  15. 15.

    Song WS, Jeon DG, Cho WH, et al. Clinical outcome of paraosteal osteosarcoma. J Korean Bone Joint Tumor Soc. 2013;19(1):20–7.

    Article  Google Scholar 

  16. 16.

    Lindell MM Jr, Shirkhoda A, Raymond AK, Murray JA, Harle TS. Parosteal osteosarcoma: radiologic-pathologic correlation with emphasis on CT. AJR Am J Roentgenol. 1987;148:323–8.

    Article  Google Scholar 

  17. 17.

    Tariq MU, Uddin N, Ahmed A. Challenges and pitfalls in diagnosis of paraosteal osteosarcoma: a clinicopathologic study of 23 cases. Journal of Solid Tumours. 2016;6(2):17–24.

    Google Scholar 

  18. 18.

    Levine E, De Smet AA, Huntrakoon M. Juxtacortical osteosarcoma: a radiologic and histologic spectrum. Skelet Radiol. 1985;14(1):38–46.

    CAS  Article  Google Scholar 

  19. 19.

    Schajowicz F, McGuire MH, Santini Araujo E, et al. Osteosarcomas arising on the surfaces of long bones. J Bone Joint Surg Am. 1988;70:555–64.

    CAS  Article  Google Scholar 

  20. 20.

    Ritschl P, Wurnig C, Lechner G, et al. Parosteal osteosarcoma. 2–23-year follow-up of 33 patients. Acta Orthop Scand. 1991;62(3):195–200.

    CAS  Article  Google Scholar 

  21. 21.

    Sheth DS, Yasko AW, Raymond AK, et al. Conventional and dedifferentiated parosteal osteosarcoma. Diagnosis, treatment, and outcome. Cancer. 1996;78(10):2136–45.

    CAS  Article  Google Scholar 

  22. 22.

    Funovics PT, Bucher F, Toma CD, et al. Treatment and outcome of parosteal osteosarcoma: biological versus endoprosthetic reconstruction. J Surg Oncol. 2011;103(8):782–9.

    Article  Google Scholar 

  23. 23.

    Han I, Oh JH, Na YG, et al. Clinical outcome of parosteal osteosarcoma. J Surg Oncol. 2008;97(2):146–9.

    Article  Google Scholar 

  24. 24.

    Temple HT, Scully SP, O'Keefe RJ, et al. Clinical outcome of 38 patients with juxtacortical osteosarcoma. Clin Orthop Relat Res. 2000;373:208–17.

    Article  Google Scholar 

  25. 25.

    Takeuchi K, Morii T, Yabe H, et al. Dedifferentiated parosteal osteosarcoma with well-differentiated metastases. Skelet Radiol. 2006;35(10):778–82.

    Article  Google Scholar 

  26. 26.

    Nodomi S, Umeda K, Okamoto T, et al. A pediatric case of metastatic conventional Parosteal osteosarcoma treated with multidrug chemotherapy. Pediatr Blood Cancer. 2016;63(8):1471–3.

    Article  Google Scholar 

  27. 27.

    Caparica R, Mak MP, Rocha CH, et al. Pulmonary nodules in patients with non-pulmonary cancer: not always metastases. J Glob Oncol. 2016;2(3):138–44.

    Article  Google Scholar 

  28. 28.

    Ghosh KM, Lee LH, Beckingsale TB, et al. Indeterminate nodules in osteosarcoma: what’s the follow-up? Br J Cancer. 2018;118(5):634–8.

    CAS  Article  Google Scholar 

  29. 29.

    Jackson JB 3rd, Kneisl JS. Parosteal osteosarcoma of the 2nd metatarsal. Am J Orthop (Belle Mead NJ). 2013;42(12):557–560.

  30. 30.

    Tozum H, Aydemir AN, Demiroglu M, Ozkan K, Ceyran AB, Kılıc B. A rare rib lesion due to parosteal osteosarcoma: a case report. J Med Case Rep. 2019;13(1):19.

    Article  Google Scholar 

  31. 31.

    Sanghavi S, Wahegaonkar A, Panchwagh Y, Kharat A. Parosteal osteosarcoma of the distal radius mimicking an osteochondroma-a diagnostic misadventure. J Hand Surg Am. 2017;42(12):1038.e1–1038.e10.

  32. 32.

    Gupta S, Parikh S, Goel S. Parosteal osteosarcoma of mandible: a rare case report. J Cancer Res Ther. 2018;14(2):471–4.

    PubMed  Google Scholar 

  33. 33.

    Kumar VS, Barwar N, Khan SA. Surface osteosarcomas: diagnosis, treatment and outcome. Indian J Orthop. 2014;48(3):255–61.

    Article  Google Scholar 

  34. 34.

    Xie L, Huang W, Wang H, et al. Risk factors for lung metastasis at presentation with malignant primary osseous neoplasms: a population-based study. J Orthop Surg Res. 2020;15(1):32.

    Article  Google Scholar 

  35. 35.

    Jeffree GM, Price CH, Sissons HA. The metastatic patterns of osteosarcoma. Br J Cancer. 1975;32(1):87–107.

    CAS  Article  Google Scholar 

  36. 36.

    Salah S, Ahmad R, Sultan I. Osteosarcoma with metastasis at initial diagnosis: current outcomes and prognostic factors in the context of a comprehensive cancer center. Molecular and Clinical Oncology. 2014;2:811–6.

    Article  Google Scholar 

  37. 37.

    Liu F, Zhang Q, Zhou D, et al. Effectiveness of 18F-FDG PET/CT in the diagnosis and staging of osteosarcoma: a meta-analysis of 26 studies. BMC Cancer. 2019;19(1):323.

    Article  Google Scholar 

  38. 38.

    Hurley C, McCarville MB, Shulkin BL, et al. Comparison of (18) F-FDG-PET-CT and bone scintigraphy for evaluation of osseous metastases in newly diagnosed and recurrent osteosarcoma. Pediatr Blood Cancer. 2016;63(8):1381–6.

    Article  Google Scholar 

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Correspondence to R. Rajakulasingam.

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Rajakulasingam, R., Attard, V., Botchu, R. et al. The value of chest and skeletal staging in parosteal osteosarcoma: two-centre experience and literature review. Skeletal Radiol 50, 301–309 (2021). https://doi.org/10.1007/s00256-020-03557-y

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Keywords

  • Parosteal osteosarcoma
  • Chest CT
  • Whole-body bone scintigraphy
  • Whole-body MRI