General and Thoracic Surgery, The Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy.
Eur J Radiol. 2013 Dec;82(12):2070-5. doi: 10.1016/j.ejrad.2011.11.029. Epub 2011 Dec 30.
Primary malignant chest wall tumors are rare. The most frequent primary malignant tumor of the chest wall is chondrosarcoma, less common are primary bone tumors belonging to the Ewing Family Bone Tumors (EFBT), or even rarer are osteosarcomas. They represent a challenging clinical entities for surgeons as the treatment of choice for these neoplasms is surgical resection, excluding EFBT which are normally treated by a multidisciplinary approach. Positive margins after surgical procedure are the principal risk factor of local recurrence, therefore to perform adequate surgery a correct preoperative staging is mandatory. Imaging techniques are used for diagnosis, to determine anatomic site and extension, to perform a guided biopsy, for local and general staging, to evaluate chemotherapy response, to detect the presence of a recurrence. This article will focus on the role of imaging in guiding this often difficult surgery and the different technical possibilities adopted in our department to restore the mechanics of the thoracic cage after wide resections.
原发性胸壁恶性肿瘤较为罕见。胸壁最常见的原发性恶性肿瘤为软骨肉瘤，较少见的是属于尤因氏骨肿瘤（Ewing Family Bone Tumors，EFBT）的原发性骨肿瘤，甚至更罕见的是骨肉瘤。对于外科医生来说，这些肿瘤是具有挑战性的临床实体，因为这些肿瘤的治疗选择是手术切除，EFBT 除外，EFBT 通常采用多学科方法治疗。手术切除后的阳性边缘是局部复发的主要危险因素，因此为了进行充分的手术，术前正确的分期是必要的。影像学技术用于诊断、确定解剖部位和范围、进行引导性活检、进行局部和全身分期、评估化疗反应、检测复发情况。本文将重点介绍影像学在指导这一常见困难手术中的作用，以及我们科室在广泛切除后恢复胸壁力学所采用的不同技术可能性。
