锁骨病变的解剖分布、恶性肿瘤发生率和诊断评估：410 例病例回顾。
Anatomical distribution, the incidence of malignancy and diagnostic workup in the pathological lesions of the clavicle: a review of 410 cases.
机构信息
The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK.
出版信息
Arch Orthop Trauma Surg. 2023 Jun;143(6):2981-2987. doi: 10.1007/s00402-022-04511-4. Epub 2022 Jul 1.
BACKGROUND
The clavicle poses a diagnostic dilemma of the pathological lesions due to the wide range of pathologies seen at this site. This study aimed to identify and stratify various pathologies seen in the clavicle and to guide ways of investigation for diagnosis based on age, site and investigation findings.
MATERIALS AND METHODS
Four hundred and ten cases with clavicle lesions were identified in our database. Data were collected about the patient's medical history, previous investigation, inflammatory markers radiological investigations and biopsy. All patients were worked up and managed after discussion in a multidisciplinary team meeting (MDT).
RESULTS
Non-malignant lesions accounted for 79% of cases. Infection was the most common diagnosis (39%) and the commonest diagnosis in those less than 20 years of age. 73% of the lesions were found at the medial end of the clavicle. Malignant tumours were 21%, while primary benign bone tumours accounted for only 14%. 50% of the malignant lesions were due to metastatic disease. The risk of malignancy increases with advancing age. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were not sensitive as a diagnostic tool in cases of osteomyelitis confirmed by histology. Magnetic resonance imaging (MRI) was noted to have high sensitivity and specificity for identifying the nature of a lesion and diagnosis.
CONCLUSION
We have identified age as a positive predictor of a malignant cause in pathological lesions of the clavicle. MRI should be considered in all these cases. CRP and ESR have poor predictive values in diagnosing infection in the clavicle. Patients presenting with clavicle lesions should be discussed in a specialist MDT and undergo a systemic diagnostic workup, still in some cases, diagnosis can be speculated based on the patient's age, location of the lesion within the clavicle and the features seen on the MRI scan.
LEVEL OF EVIDENCE
IV.
背景
锁骨由于在此处可见的广泛病变而构成了病理病变的诊断难题。本研究旨在确定并分层各种锁骨病变，并根据年龄、部位和调查结果为诊断提供指导调查方法。
材料和方法
在我们的数据库中确定了 410 例锁骨病变患者。收集了有关患者病史、先前检查、炎症标志物、影像学检查和活检的资料。所有患者均在多学科团队会议（MDT）讨论后进行了检查和管理。
结果
非恶性病变占 79%。感染是最常见的诊断（39%），也是 20 岁以下患者最常见的诊断。73%的病变位于锁骨的内侧端。恶性肿瘤占 21%，而原发性良性骨肿瘤仅占 14%。50%的恶性病变是由于转移性疾病。随着年龄的增长，恶性肿瘤的风险增加。红细胞沉降率（ESR）和 C 反应蛋白（CRP）在组织学证实的骨髓炎病例中作为诊断工具并不敏感。磁共振成像（MRI）被认为对识别病变性质和诊断具有高度敏感性和特异性。
结论
我们已经确定年龄是锁骨病理性病变恶性原因的阳性预测因子。在所有这些情况下都应考虑 MRI。CRP 和 ESR 在诊断锁骨感染方面的预测值较差。出现锁骨病变的患者应在专科 MDT 中进行讨论，并进行系统性诊断检查，但在某些情况下，仍可以根据患者的年龄、锁骨内病变的位置以及 MRI 扫描所见的特征来推测诊断。
证据水平
IV。
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