Skip to main content

The importance of MRI review following the diagnosis of atypical cartilaginous tumour using image-guided needle biopsy



To evaluate the role of pre-biopsy MRI for management planning in patients with atypical cartilaginous tumours (ACT) diagnosed on image-guided core needle biopsy (IGCNB).

Materials and methods

Retrospective review of patients diagnosed with ACT of the appendicular skeleton based on IGCNB who subsequently underwent surgical curettage or resection. Data collected included age, sex, skeletal location and surgical histology classified as ACT, high-grade chondrosarcoma (HG-CS) and dedifferentiated chondrosarcoma (DD-CS). Pre-biopsy MRI studies were reviewed independently by 2 radiologists blinded to surgical histology results and graded as ACT, HG-CS and DD-CS based on MRI features.


The study included 24 males and 28 females (mean age 42.1 years; range 9–76 years). One patient had 2 lesions treated, making a total of 53 lesions. Tumours were located in the femur in 21 cases, humerus in 17, tibia in 9, radius in 4 and ulna and fibula in 1 each. Surgical histology was ACT in 41 cases, HG-CS in 10 and DD-CS in 2, indicating mismatch between IGCNB and surgical histology in 12/53 cases (22.6%). Predicted MRI grade for the 2 readers was ACT in 39 cases each, HG-CS in 13 and 14 cases and DD-CS in 1 and 0 cases. Sensitivity, specificity and accuracy of MRI for predicting HG-CS/DD-CS were 91%, 93% and 92%, respectively. Inter-observer correlation was very good (kappa = 0.94).


Review of MRI findings in patients with ACT diagnosed on IGCNB is vital for identifying patients with a HG-CS/DD-CS and is recommended when planning surgical management or considering repeat IGCNB.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7


  1. 1.

    Whelan JS, Davis LE. Osteosarcoma, chondrosarcoma, and chordoma. J Clin Oncol Off J Am Soc Clin Oncol. 2018;36:188–93.

    CAS  Article  Google Scholar 

  2. 2.

    Francis M, Dennis N, Charman J, Lawrence G, Grimer R. Bone and soft tissue sarcomas. UK incidence and survival: 1996 to 2010. [Internet]. National Cancer Intelligence Network; 2013. Available from:

  3. 3.

    Rozeman LB, Cleton-Jansen AM, Hogendoorn PCW. Pathology of primary malignant bone and cartilage tumours. Int Orthop. 2006;30:437–44.

    CAS  Article  Google Scholar 

  4. 4.

    Shemesh SS, Acevedo-Nieves JD, Pretell-Mazzini J. Treatment strategies for central low-grade chondrosarcoma of long bones: a systematic review of the literature and meta-analysis. Musculoskelet Surg. 2018;102:95–109.

    CAS  Article  Google Scholar 

  5. 5.

    Nota SPFT, Braun Y, Schwab JH, van Dijk CN, Bramer JAM. The identification of prognostic factors and survival statistics of conventional central chondrosarcoma. Sarcoma. 2015;2015:623746.

    Article  Google Scholar 

  6. 6.

    Fromm J, Klein A, Baur-Melnyk A, Knösel T, Lindner L, Birkenmaier C, et al. Survival and prognostic factors in conventional central chondrosarcoma. BMC Cancer. 2018;18:849.

    Article  Google Scholar 

  7. 7.

    Miao R, Choy E, Raskin KA, Schwab JH, Nielsen GP, Deshpande V, et al. Prognostic factors in dedifferentiated chondrosarcoma: a retrospective analysis of a large series treated at a single institution. Sarcoma. 2019;2019:9069272.

    Article  Google Scholar 

  8. 8.

    Dierselhuis EF, Goulding KA, Stevens M, Jutte PC. Intralesional treatment versus wide resection for central low-grade chondrosarcoma of the long bones. Cochrane Database Syst Rev. 2019;3:CD010778.

    PubMed  Google Scholar 

  9. 9.

    Laitinen MK, Stevenson JD, Parry MC, Sumathi V, Grimer RJ, Jeys LM. The role of grade in local recurrence and the disease-specific survival in chondrosarcomas. Bone Joint J. 2018;100-B:662–6.

    CAS  Article  Google Scholar 

  10. 10.

    Dickey ID, Rose PS, Fuchs B, Wold LE, Okuno SH, Sim FH, et al. Dedifferentiated chondrosarcoma: the role of chemotherapy with updated outcomes. J Bone Joint Surg Am. 2004;86:2412–8.

    Article  Google Scholar 

  11. 11.

    Gerrand C, Athanasou N, Brennan B, Grimer R, Judson I, Morland B, et al. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res. 2016;6:7.

    Article  Google Scholar 

  12. 12.

    Jennings R, Riley N, Rose B, Rossi R, Skinner JA, Cannon SR, et al. An evaluation of the diagnostic accuracy of the grade of preoperative biopsy compared to surgical excision in chondrosarcoma of the long bones. Int J Surg Oncol. 2010;2010:270195.

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Roitman PD, Farfalli GL, Ayerza MA, Múscolo DL, Milano FE, Aponte-Tinao LA. Is needle biopsy clinically useful in preoperative grading of central chondrosarcoma of the pelvis and long bones? Clin Orthop Relat Res. 2017;475:808–14.

    Article  Google Scholar 

  14. 14.

    Stevenson JD, Laitinen MK, Parry MC, Sumathi V, Grimer RJ, Jeys LM. The role of surgical margins in chondrosarcoma. Eur J Surg Oncol. 2018;44:1412–8.

    Article  Google Scholar 

  15. 15.

    Oliveira I, Chavda A, Rajakulasingam R, Saifuddin A. Chondral tumours: discrepancy rate between needle biopsy and surgical histology. Skelet Radiol. 2020;49:1115–25.

    Article  Google Scholar 

  16. 16.

    Skeletal Lesions Interobserver Correlation among Expert Diagnosticians (SLICED) Study Group. Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am. 2007;89:2113–23.

    Article  Google Scholar 

  17. 17.

    Yoshimura Y, Isobe K, Arai H, Aoki K, Kito M, Kato H. Preoperative radiographic and histopathologic evaluation of central chondrosarcoma. Arch Orthop Trauma Surg. 2013;133:1225–31.

    Article  Google Scholar 

  18. 18.

    Logie CI, Walker EA, Forsberg JA, Potter BK, Murphey MD. Chondrosarcoma: a diagnostic imager’s guide to decision making and patient management. Semin Musculoskelet Radiol. 2013;17:101–15.

    Article  Google Scholar 

  19. 19.

    Yoo HJ, Hong SH, Choi J-Y, Moon KC, Kim H-S, Choi J-A, et al. Differentiating high-grade from low-grade chondrosarcoma with MR imaging. Eur Radiol. 2009;19:3008–14.

    Article  Google Scholar 

  20. 20.

    Douis H, Singh L, Saifuddin A. MRI differentiation of low-grade from high-grade appendicular chondrosarcoma. Eur Radiol. 2014;24:232–40.

    Article  Google Scholar 

  21. 21.

    Fritz B, Müller DA, Sutter R, Wurnig MC, Wagner MW, Pfirrmann CWA, et al. Magnetic resonance imaging-based grading of cartilaginous bone tumors: added value of quantitative texture analysis. Investig Radiol. 2018;53:663–72.

    Article  Google Scholar 

  22. 22.

    Deckers C, Steyvers MJ, Hannink G, Schreuder HWB, de Rooy JWJ, Van Der Geest ICM. Can MRI differentiate between atypical cartilaginous tumors and high-grade chondrosarcoma? A systematic review. Acta Orthop. 2020:1–8.

  23. 23.

    MacSweeney F, Darby A, Saifuddin A. Dedifferentiated chondrosarcoma of the appendicular skeleton: MRI-pathological correlation. Skelet Radiol. 2003;32:671–8.

    Article  Google Scholar 

  24. 24.

    Littrell LA, Wenger DE, Wold LE, Bertoni F, Unni KK, White LM, et al. Radiographic, CT, and MR imaging features of dedifferentiated chondrosarcomas: a retrospective review of 174 de novo cases. Radiographics. 2004;24:1397–409.

    Article  Google Scholar 

  25. 25.

    Saifuddin A, Mann BS, Mahroof S, Pringle JAS, Briggs TWR, Cannon SR. Dedifferentiated chondrosarcoma: use of MRI to guide needle biopsy. Clin Radiol. 2004;59:268–72.

    CAS  Article  Google Scholar 

  26. 26.

    Ryzewicz M, Manaster BJ, Naar E, Lindeque B. Low-grade cartilage tumors: diagnosis and treatment. Orthopedics. 2007;30:35–46 quiz 47–8.

    Article  Google Scholar 

  27. 27.

    Shemesh SS, Pretell-Mazzini J, Quartin PAJ, Rutenberg TF, Conway SA. Surgical treatment of low-grade chondrosarcoma involving the appendicular skeleton: long-term functional and oncological outcomes. Arch Orthop Trauma Surg. 2019;139:1659–66.

    Article  Google Scholar 

  28. 28.

    Campanacci DA, Scoccianti G, Franchi A, Roselli G, Beltrami G, Ippolito M, et al. Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton. J Orthop Traumatol. 2013;14:101–7.

    Article  Google Scholar 

  29. 29.

    Donati D, Colangeli S, Colangeli M, Di Bella C, Bertoni F. Surgical treatment of grade I central chondrosarcoma. Clin Orthop Relat Res. 2010;468:581–9.

    Article  Google Scholar 

  30. 30.

    Berber O, Datta G, Sabharwal S, Aston W, Saifuddin A, Briggs T. The safety of direct primary excision of low-grade chondral lesions based on radiological diagnosis alone. Acta Orthop Belg. 2012;78:254–62.

    PubMed  Google Scholar 

  31. 31.

    Brown MT, Gikas PD, Bhamra JS, Skinner JA, Aston WJS, Pollock RC, et al. How safe is curettage of low-grade cartilaginous neoplasms diagnosed by imaging with or without pre-operative needle biopsy? Bone Joint J. 2014;96-B:1098–105.

    CAS  Article  Google Scholar 

  32. 32.

    Reith JD, Horodyski MB, Scarborough MT. Grade 2 chondrosarcoma: stage I or stage II tumor? Clin Orthop Relat Res. 2003:45–51.

  33. 33.

    Cho WH, Song WS, Jeon D-G, Kong C-B, Koh J-S, Kim JI, et al. Oncologic impact of the curettage of grade 2 central chondrosarcoma of the extremity. Ann Surg Oncol. 2011;18:3755–61.

Download references


The authors would like to acknowledge Mr. Paul Bassett for statistical input.

Author information



Corresponding author

Correspondence to Michael Khoo.

Ethics declarations

The study was approved by the local Research and Innovation Centre of The Institute of Orthopaedics under the Integrated Research Application System number 262826, with no requirement for informed patient consent.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Saifuddin, A., Oliveira, I., Singla, N. et al. The importance of MRI review following the diagnosis of atypical cartilaginous tumour using image-guided needle biopsy. Skeletal Radiol 50, 407–415 (2021).

Download citation


  • MRI
  • Bone neoplasms
  • Chondrosarcoma
  • Biopsy