ABSTRACT
OBJECTIVE: CT is the recommended technique for the detection of pulmonary metastases in patients affected by osteosarcoma, though claimed to show several limits compared to manual palpation. We retrospectively analyzed CT features of suspected lesions submitted to surgery to address its current accuracy and to investigate criteria for predicting histology. MATERIALS AND METHODS: CT scans of 70 patients submitted to thoracotomy between 2007-2013 were reviewed. Overall, 123 thoracotomies were performed and 283 lesions seen on CT were resected. Shape, size, presence and type of calcification, evolution of each lesion were analyzed. Number and histology of nodules detected at thoracotomy were recorded and compared to CT data. RESULTS: 234/283--82.7% Lesions were metastases; 143--61.1% were calcified; most metastases were nodular (201/234--85.9%), but in 33/234--14.1% other findings were detected (striae, consolidations, pleural plaques/masses, cavitations, ground glass opacities, irregular shapes, halo sign). Malignant lesions were more frequently calcified, larger, with progression over time--p<0.0001. Manual palpation identified 314 lesions, 248 metastatic--79.0%: CT missed 31/314--9.9% lesions, whereof 14/31--45.2% were metastases. CONCLUSIONS: Though most lesions are nodular and calcified, up to 40% are not calcified and atypical findings are not uncommon (14.1%). The identification of the atypical radiological presentation of metastases could be the key for improving CT accuracy.
Subject(s)
Bone Neoplasms/pathology , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Osteosarcoma/pathology , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Lung/diagnostic imaging , Lung/surgery , Lung Neoplasms/surgery , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Thoracotomy , Young AdultABSTRACT
OBJECTIVES: To present the results of biopsy and computed tomography (CT) guided radiofrequency ablation (RFA) for non-spinal osteoid osteomas, and compare the results before and after procedural modifications. METHODS: We retrospectively studied 557 patients with non-spinal osteoid osteomas treated with biopsy and CT-guided RFA. In 68 patients we used 3-mm CT at 2-mm intervals, 19 G/5-mm active tip electrodes, and one 4-minute ablation at 90-93°C. In 489 patients we used contiguous 1-mm CT, 20 G/5-15-mm electrodes, ablation maintaining 60°C for 2 min followed by 14-15 min at 90-93°C, and multiple ablations in the same session for large and multiform lesions. RESULTS: 533/557 patients (96%) remained asymptomatic and 24/557 (4%) had recurrence; repeat RFA was successful in 22/24 patients (92%). Biopsy was non-diagnostic in 82%. With the modifications performed, success improved from 79% to 98%, recurrences reduced from 21% to 2% and complications from 5.9% to 0.2% (p < 0.001). All patients with large and multiform lesions treated with one ablation had recurrence, compared to no patient with similar lesions and multiple ablations in the same session. CONCLUSION: Electrode parameters, duration of ablation, morphology and size of osteoid osteomas are important for RFA. The above modifications are recommended for improved outcome.
Subject(s)
Bone Neoplasms/surgery , Catheter Ablation , Osteoma, Osteoid/surgery , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Biopsy , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/pathology , Catheter Ablation/methods , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Osteoma, Osteoid/diagnostic imaging , Osteoma, Osteoid/pathology , Retrospective Studies , Surgery, Computer-Assisted/methods , Treatment Outcome , Young AdultABSTRACT
INTRODUCTION: Biopsy of the musculoskeletal system is useful in the management of bone lesions particularly in oncology but they are often challenging procedures with a significant risk of complications. Computed tomography (CT)-guided needle biopsies may decrease these risks but doubts still exist about their diagnostic accuracy. This retrospective analysis of the experience of a single institution with percutaneous CT-guided biopsy of musculoskeletal lesions evaluates the results of these biopsies for bone lesions either in the appendicular skeleton or in the spine, and defines indications. MATERIALS AND METHODS: We reviewed the results of 2027 core needle biopsies performed over the past 18 years at the authors' institution. The results obtained are subject of this paper. RESULTS: In 1567 cases the correct diagnosis was made with the first CT-guided needle biopsy (77.3% accuracy rate), in 408 cases the sample was not diagnostic and in 52 inadequate. Within 30 days these 408 patients underwent another biopsy, which was diagnostic in 340 cases with a final diagnostic accuracy of 94%. Highest accuracy rates were obtained in primary and secondary malignant lesions. Most false negative results were found in cervical lesions and in benign, pseudotumoral, flogistic, and systemic pathologies. There were 22 complications (18 transient paresis, 3 haematomas, 1 retroperitoneal haematoma) which had no influence on the treatment strategy, nor on patient outcome. CONCLUSION: This technique is reliable and safe and should be considered nowadays the gold standard for biopsies of the musculoskeletal system.
