Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano Prefecture, Japan.
Arch Orthop Trauma Surg. 2013 Sep;133(9):1225-31. doi: 10.1007/s00402-013-1800-z. Epub 2013 Jul 3.
Distinguishing grade 1 chondrosarcoma from grade 2 chondrosarcoma is critical both for planning the surgical procedure and for predicting the outcome. We aimed to review the preoperative radiographic and histologic findings, and to evaluate the reliability of preoperative grading.
We retrospectively reviewed the medical records of 17 patients diagnosed with central chondrosarcoma at our institution between 1996 and 2011. In these cases, we compared the preoperative and postoperative histologic grades, and evaluated the reliability of the preoperative histologic grading. We also assessed the preoperative radiographic findings obtained using plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI).
Preoperative histologic grade was 1 in 12 patients, 2 in 4 patients, and 3 in 1 patient. However, 6 of the 12 cases classified as grade 1 before surgery were re-classified as grade 2 postoperatively. In the radiographic evaluation, grade 1 was suspected by the presence of a ring-and-arc pattern of calcification on plain radiography and CT and entrapped fat and ring-and-arc enhancement on MRI. Grades 2 and 3 were suspected by the absence of calcification and the presence of cortical penetration and endosteal scalloping on plain radiography and CT, as well as soft-tissue mass formation on MRI.
Although the combination of radiographic interpretation and histologic findings may improve the accuracy of preoperative grading in chondrosarcoma, the establishment of a standard evaluation system with the histologic and radiographic findings and/or the development of new biologic markers are necessary for preoperative discrimination of low-grade chondrosarcoma from high-grade chondrosarcoma.
区分 1 级软骨肉瘤和 2 级软骨肉瘤对于规划手术方案和预测预后都至关重要。我们旨在回顾术前影像学和组织学表现，并评估术前分级的可靠性。
我们回顾性分析了 1996 年至 2011 年期间在我院诊断为中央软骨肉瘤的 17 例患者的病历。在这些病例中，我们比较了术前和术后的组织学分级，并评估了术前组织学分级的可靠性。我们还评估了使用普通放射摄影、计算机断层扫描（CT）和磁共振成像（MRI）获得的术前影像学发现。
术前组织学分级 1 级 12 例，2 级 4 例，3 级 1 例。然而，术前分类为 1 级的 12 例中有 6 例术后重新分类为 2 级。在影像学评估中，普通放射摄影和 CT 上存在环弧型钙化模式以及 MRI 上存在包绕的脂肪和环弧型强化提示 1 级。普通放射摄影和 CT 上不存在钙化以及皮质穿透和骨内切迹，以及 MRI 上存在软组织肿块形成提示 2 级和 3 级。
虽然结合影像学解释和组织学发现可以提高软骨肉瘤术前分级的准确性，但需要建立具有组织学和影像学发现的标准评估系统，或者开发新的生物学标志物，以便在术前区分低级别软骨肉瘤和高级别软骨肉瘤。
