Johnson Samuel R, Hajdu Katherine S, Quirion Julia C, Chenard Stephen W, Moran Cullen P, Rees Andrew B, Coiner Ben L, Norris James P, Kang Hakmook, Shechtel Joanna L, Chadwick Nicholson S, Smith David S, Singh Reena, Prieto-Granada Carlos, Halpern Jennifer L, Schwartz Herbert S, Holt Ginger E, Lawrenz Joshua M
From the Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN (Dr. Johnson, Hajdu, Dr. Quirion, Chenard, Moran, Dr. Rees, Coiner, Dr. Halpern, Dr. Schwartz, Dr. Holt, and Dr. Lawrenz); the Department of Orthopaedic Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC (Dr. Norris IV); the Department of Biostatistics, Vanderbilt University Medical Center (Dr. Kang); the Department of Radiology, Vanderbilt University Medical Center (Dr. Shechtel, Dr. Chadwick, and Dr. Smith); and the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN (Dr. Singh, and Dr. Prieto-Granada).
J Am Acad Orthop Surg Glob Res Rev. 2025 Feb 3;9(2). doi: 10.5435/JAAOSGlobal-D-24-00370. eCollection 2025 Feb 1.
Differentiating benign and malignant myxoid soft-tissue tumors preoperatively can be challenging due to shared clinical, imaging, and histologic features. Biopsy specimens are frequently described as "low-grade myxoid neoplasms" without benign or malignant classification (ie, indeterminate). Our purpose is to evaluate the prevalence and prognosis of myxoid tumors with an indeterminate diagnosis before resection.
A retrospective review identified 439 patients with a musculoskeletal myxoid soft-tissue tumor confirmed on final resection pathology. Biopsy result (benign, malignant, indeterminate) for each biopsy type was compared with the final resection diagnosis. Indeterminate diagnosis before resection was defined as when the preoperative diagnosis was uncertain to be benign or malignant based on all biopsy data. For patients with sarcomas on final resection and 2-year follow-up, the prevalence of positive margins and local recurrence were compared between patients with an indeterminate diagnosis before resection and those with a malignant diagnosis known preoperatively.
The prevalence of indeterminate diagnosis before resection was 28% (66/235). In these patients with sarcomas on final resection and 2-year follow-up, the positive margin rate at resection surgery was 37% (10/27) compared with 15% (11/74) in patients with a malignant diagnosis known preoperatively (P = 0.049). Their 5-year local recurrence-free survival was 73% (95% confidence interval, 58 to 92) compared with 92% (95% confidence interval, 86 to 98) in patients with a malignant diagnosis known preoperatively (P = 0.022).
Indeterminate diagnosis before resection in myxoid tumors is relatively common, compared with prior reports in nonmyxoid neoplasms. Patients with indeterminate diagnosis before resection had two times higher rate of positive margins at resection surgery and markedly shorter local recurrence-free survival at 5 years compared with patients with malignant diagnosis known preoperatively. Diagnostic uncertainty at the time of resection is associated with worse oncologic outcomes in myxoid tumors.
由于临床、影像学和组织学特征存在共性，术前鉴别良性和恶性黏液样软组织肿瘤具有挑战性。活检标本常被描述为“低级别黏液样肿瘤”，但未进行良性或恶性分类（即诊断不明确）。我们的目的是评估切除术前诊断不明确的黏液样肿瘤的患病率和预后。
一项回顾性研究纳入了439例经最终切除病理确诊为肌肉骨骼黏液样软组织肿瘤的患者。将每种活检类型的活检结果（良性、恶性、不明确）与最终切除诊断进行比较。切除术前诊断不明确定义为根据所有活检数据，术前诊断无法确定为良性或恶性。对于最终切除为肉瘤且随访2年的患者，比较切除术前诊断不明确的患者与术前已知为恶性诊断的患者的切缘阳性率和局部复发率。
切除术前诊断不明确的患病率为28%（66/235）。在这些最终切除为肉瘤且随访2年的患者中，切除手术时的切缘阳性率为37%（10/27），而术前已知为恶性诊断的患者为15%（11/74）（P = 0.049）。他们的5年无局部复发生存率为73%（95%置信区间，58至92），而术前已知为恶性诊断的患者为92%（95%置信区间，86至98）（P = 0.022）。
与之前非黏液样肿瘤的报道相比，黏液样肿瘤切除术前诊断不明确相对常见。切除术前诊断不明确的患者在切除手术时的切缘阳性率比术前已知为恶性诊断的患者高两倍，且5年无局部复发生存期明显更短。切除时的诊断不确定性与黏液样肿瘤更差的肿瘤学结局相关。
