Chang Yu-Cherng, Pretell-Mazzini Juan, Temple H Thomas, Soler Roxana, Purrinos Julian, Rosenberg Andrew E, Jonczak Emily, Subhawong Ty K
From the Department of Radiology, Jackson Memorial Hospital, Miami, FL (Dr. Chang); the Baptist Heath South Florida, Plantation, FL (Dr. Pretell-Mazzini); the Department of Orthopaedics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL (Dr. Temple); the Nova Southeastern School of Allopathic Medicine, Davis, FL (Dr. Soler); the Leonard M. Miller School of Medicine, University of Miami (Mr. Purrinos); the Department of Pathology and Laboratory Medicine, Leonard M. Miller School of Medicine, University of Miami (Dr. Rosenberg); Department of Medicine, Division of Hematology and Oncology, Leonard M. Miller School of Medicine, University of Miami (Dr. Jonczak); and the Musculoskeletal Radiology Division, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL (Dr. Subhawong).
J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 17;9(7). doi: 10.5435/JAAOSGlobal-D-24-00321. eCollection 2025 Jul 1.
Conventional classification systems for giant cell tumors (GCTs) lack robust correlation with management and clinical outcomes. We propose a new radiologic classification system based on surgically relevant features to address this shortcoming.
This IRB-approved single-institution retrospective study involved 35 extremity GCTs from 2013 to 2023 with preoperative radiographs and cross-sectional imaging (MRI and/or CT). An experienced musculoskeletal (MSK) radiologist and orthopaedic oncologist independently assessed tumors according to the Campanacci or new grading system, defined on 1 to 3 scale: (1) intraosseous contained tumor, (2) intraosseous noncontained tumor with extraosseous implant accessible through single incision, and (3) intraosseous noncontained tumor with an extraosseous soft tissue implant nonaccessible from single incision alone. Interrater agreement was determined through the intraclass correlation coefficient. The two-way Friedman test with rater and grading system as factors was used to compare system grading similarity.
Thirty patients underwent curettage, five underwent resection; 10 experienced local recurrence. Intraclass correlation coefficients between raters for the Campanacci and novel grading systems were 0.83 and 0.79, respectively. However, compared with the novel system, Campanacci grades were significantly higher by an average of 0.34 ± 0.68 and 0.46 ± 0.70 for the first and second raters, respectively (P = 0.003). None of the patients who underwent resection experienced local recurrence, but in patients who underwent curettage, recurrence rates were higher in Campanacci versus novel grade 1 tumors (29% vs. 17%).
The novel GCT grading system demonstrates excellent interrater agreement, and classified more nonrecurrent curetted tumors as low grade, suggesting improved predictive performance compared with the Campanacci classification.
传统的骨巨细胞瘤（GCT）分类系统与治疗方法及临床结果缺乏紧密关联。我们提出一种基于手术相关特征的新放射学分类系统以弥补这一不足。
这项经机构审查委员会批准的单机构回顾性研究纳入了2013年至2023年期间35例四肢GCT患者，这些患者均有术前X线片及断层成像（MRI和/或CT）。一位经验丰富的肌肉骨骼（MSK）放射科医生和一位骨肿瘤学家根据坎帕纳奇（Campanacci）分级系统或新分级系统独立评估肿瘤，新分级系统按1至3级定义：（1）骨内局限肿瘤；（2）骨内非局限肿瘤且可通过单一切口触及骨外植入物；（3）骨内非局限肿瘤且有骨外软组织植入物，无法仅通过单一切口触及。通过组内相关系数确定评分者间的一致性。以评分者和分级系统为因素的双向弗里德曼检验用于比较系统分级的相似性。
30例患者接受了刮除术，5例接受了切除术；10例出现局部复发。坎帕纳奇分级系统和新分级系统评分者间的组内相关系数分别为0.83和0.79。然而，与新系统相比，第一位评分者的坎帕纳奇分级平均显著高出0.34±0.68，第二位评分者高出0.46±0.70（P = 0.003）。接受切除术的患者均未出现局部复发，但在接受刮除术的患者中，坎帕纳奇1级肿瘤的复发率高于新分级1级肿瘤（29%对17%）。
新的GCT分级系统显示出极好的评分者间一致性，且将更多未复发的刮除肿瘤归为低级别，表明与坎帕纳奇分类相比，其预测性能有所改善。
