Skip to main content
SpringerLink
Log in

Diagnostik von malignen Knochen- und Weichteiltumoren

Diagnosis of malignant bone and soft tissue tumors

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Primäre Knochensarkome sind selten, stellen aber eine bedeutende Ursache für Sterblichkeit im Kindes- und Jugendalter dar. Ziel der präoperativen Evaluation sind die histologische Diagnosestellung, Abgrenzung der Befundausdehnung und Erstellung eines Therapieplans. Neben Anamnese und klinischer Untersuchung ist v. a. das Röntgenbild wichtig. Zentrale Bedeutung zur weiteren Abklärung hat die Magnetresonanztomographie. Die Computertomographie (CT) besitzt bei der Diagnostik von Tumoren des Achsenskeletts sowie bei Staginguntersuchungen hohen Stellenwert. Das PET-CT (PET: Positronenemissionstomographie) findet zur Aufdeckung weiterer Tumorlokalisationen Anwendung. Die Biopsie als letzter Schritt sollte von der Institution durchgeführt werden, an der die endgültige Therapie erfolgt. Komplikationen (Fraktur, Nervenschädigung, Tumorzellverschleppung...) sind bei sachgemäßer Durchführung selten, postoperativ ist eine vorübergehende Entlastung der Extremität zu empfehlen.

Abstract

Primary sarcoma of bone is a rare entity but nevertheless a significant cause of mortality in children and adolescents. The focus of the preoperative evaluation is to set up a histological diagnosis, define local tumor extent and develop a therapy regimen. In addition to patient history and clinical findings a radiograph in two orthogonal planes is still of great importance. MRI plays a major role in the further clarification of the diagnosis, while CT is valuable in the diagnosis of tumors of the axial skeleton as well as in systemic staging. A PET-CT can be performed to obtain an overview of further tumor sites. Open bone biopsy is the final diagnostic step and should be carried out at the institution where the definitive treatment will be performed. Complications such as fracture, neural lesions and spread of tumor cells are relatively rare if the biopsy is performed appropriately; however, patients should be instructed to strictly avoid weight-bearing on the affected extremity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Babu NV, Titus VT, Chittaranjan S et al (1994) Computed tomographically guided biopsy of the spine. Spine 19:2436–2442

    Article  PubMed  CAS  Google Scholar 

  2. Bickels J, Jelinek JS, Shmookler BM et al (1999) Biopsy of musculoskeletal tumors. Current concepts. Clin Orthop Relat Res 368:212–219

    Article  PubMed  Google Scholar 

  3. Bieling P, Rehan N, Winkler P et al (1996) Tumor size and prognosis in aggressively treated osteosarcoma. J Clin Oncol 14:848–858

    PubMed  CAS  Google Scholar 

  4. Bommer KK, Ramzy I, Mody D (1997) Fine-needle aspiration biopsy in the diagnosis and management of bone lesions: a study of 450 cases. Cancer 81:148–156

    Article  PubMed  CAS  Google Scholar 

  5. Campanacci M (1999) Bone and soft tissue tumors: clinical features, imaging, pathology and treatment. Springer, Berlin Heidelberg New York

  6. Clark CR, Morgan C, Sonstegard DA et al (1977) The effect of biopsy-hole shape and size on bone strength. J Bone Joint Surg Am 59:213–217

    PubMed  CAS  Google Scholar 

  7. Davies NM, Livesley PJ, Cannon SR (1993) Recurrence of an osteosarcoma in a needle biopsy track. J Bone Joint Surg Br 75:977–978

    PubMed  CAS  Google Scholar 

  8. Dorfman HD, Czernak B (1998) Bone tumors. Mosby, St Louis

  9. Dupuy DE, Rosenberg AE, Punyaratabandhu T et al (1998) Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol 171:759–762

    PubMed  CAS  Google Scholar 

  10. Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. J Bone Joint Surg Am 62:1027–1030

    PubMed  CAS  Google Scholar 

  11. Franzius C, Sciuk J, Daldrup-Link HE et al (2000) FDG-PET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med 27:1305–1311

    Article  PubMed  CAS  Google Scholar 

  12. Franzius C, Daldrup-Link HE, Sciuk J et al (2001) FDG-PET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol 12:479–486

    Article  PubMed  CAS  Google Scholar 

  13. Grimer RJ, Briggs TW (2010) Earlier diagnosis of bone and soft-tissue tumours. J Bone Joint Surg Br 92:1489–1492

    Article  PubMed  CAS  Google Scholar 

  14. Grimer R, Athanasou N, Gerrand C et al (2010) UK guidelines for the management of bone sarcomas. Sarcoma 2010:317462

    PubMed  Google Scholar 

  15. Hau A, Kim I, Kattapuram S et al (2002) Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 31:349–353

    Article  PubMed  Google Scholar 

  16. Jelinek JS, Murphey MD, Welker JA et al (2002) Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology 223:731–737

    Article  PubMed  Google Scholar 

  17. Kornblum MB, Wesolowski DP, Fischgrund JS et al (1998) Computed tomography-guided biopsy of the spine. A review of 103 patients. Spine 23:81–85

    Article  PubMed  CAS  Google Scholar 

  18. Leffler SG, Chew FS (1999) CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic yield and accuracy. AJR Am J Roentgenol 172:1389–1392

    PubMed  CAS  Google Scholar 

  19. Lodwick GS, Wilson AJ, Farrell C et al (1980) Determining growth rates of focal lesions of bone from radiographs. Radiology 134:577–583

    PubMed  CAS  Google Scholar 

  20. Mankin HJ, Mankin CJ, Simon MA (1996) The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am 78:656–663

    PubMed  CAS  Google Scholar 

  21. Markel DC, Neumann KU, Steinau HU (1994) Appropriate techniques for musculoskeletal tumor biopsy. Orthop Rev 23:176–180

    PubMed  CAS  Google Scholar 

  22. Peabody TD, Simon MA (1996) Making the diagnosis: keys to a successful biopsy in children with bone and soft-tissue tumors. Orthop Clin North Am 27:453–459

    PubMed  CAS  Google Scholar 

  23. Picci P, Sangiorgi L, Rougraff BT et al (1994) Relationship of chemotherapy-induced necrosis and surgical margins to local recurrence in osteosarcoma. J Clin Oncol 12:2699–2705

    PubMed  CAS  Google Scholar 

  24. Rechl H, Wörtler K, Weirich G et al. (2006) Weichteilsarkome – Epidemiologie, Diagnostik und Therapie. Orthopade 35:1269–1278

    Article  PubMed  CAS  Google Scholar 

  25. Saifuddin A, Mitchell R, Burnett SJ et al (2000) Ultrasound-guided needle biopsy of primary bone tumours. J Bone Joint Surg Br 82:50–54

    Article  PubMed  CAS  Google Scholar 

  26. Schwartz HS, Spengler DM (1997) Needle tract recurrences after closed biopsy for sarcoma: three cases and review of the literature. Ann Surg Oncol 4:228–236

    Article  PubMed  CAS  Google Scholar 

  27. Simon MA, Biermann JS (1993) Biopsy of bone and soft-tissue lesions. J Bone Joint Surg Am 75:616–621

    PubMed  CAS  Google Scholar 

  28. Skrzynski MC, Biermann JS, Montag A et al (1996) Diagnostic accuracy and charge-savings of outpatient core needle biopsy compared with open biopsy of musculoskeletal tumors. J Bone Joint Surg Am 78:644–649

    PubMed  CAS  Google Scholar 

  29. Wuisman P, Enneking WF (1990) Prognosis for patients who have osteosarcoma with skip metastasis. J Bone Joint Surg Am 72:60–68

    PubMed  CAS  Google Scholar 

  30. Wunder JS, Healey JH, Davis AM et al (2000) A comparison of staging systems for localized extremity soft tissue sarcoma. Cancer 88:2721–2730

    Article  PubMed  CAS  Google Scholar 

  31. Yanagawa T, Shinozaki T, Iizuka Y et al (2010) Role of 2-deoxy-2-[F-18] fluoro-D-glucose positron emission tomography in the management of bone and soft-tissue metastases. J Bone Joint Surg Br 92:419–423

    Article  PubMed  CAS  Google Scholar 

  32. Yao L, Nelson SD, Seeger LL et al (1999) Primary musculoskeletal neoplasms: effectiveness of core-needle biopsy. Radiology 212:682–686

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    H. Rechl, C. Kirchhoff, U. Lenze, A. Töpfer & R. von Eisenhart-Rothe

  2. Institut für Röntgendiagnostik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    K. Wörtler

Authors
  1. H. Rechl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Kirchhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Wörtler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Lenze
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Töpfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. von Eisenhart-Rothe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Rechl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rechl, H., Kirchhoff, C., Wörtler, K. et al. Diagnostik von malignen Knochen- und Weichteiltumoren. Orthopäde 40, 931–944 (2011). https://doi.org/10.1007/s00132-011-1821-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-011-1821-7

Schlüsselwörter

Keywords

Search

Navigation