19. Initial assessment of the value of magnetic resonance imaging in evaluating limb-sparing surgery for primary long-bone cancer through cluster of cases
Main Article Content
Abstract
The objective of this study was to assess the accuracy of MRI in detecting tumor margins during limb-sparing surgery for primary long malignant bone tumors in children. The study involved 15 patients (mean age of 11.53 ± 2.32 years), all diagnosed with primary long bone cancer through histopathology, who underwent MRI before and after neoadjuvant chemotherapy. Osteosarcoma was found in 14 cases, while Ewing sarcoma was found in 1 case. The most frequent location of the tumor was around the knee joint (73.33%). The correlation coefficient between MRI and macroscopic MBH for evaluating tumor length was r = 0.941, p < 0.001. For soft tissue involvement, the combined use of STIR, T2W, and T1 post-gadolinium sequences had a sensitivity of 91.67% and a specificity of 66.67%. Meanwhile, for predicting invasion vascular, the sensitivity was 100% and the specificity was 92.31%; for invasion epiphyseal involvement, the sensitivity and the specificity were both 100%. Notably, no patient presented with joint invasion on MRI or histopathological examination in the study. These findings suggest that preoperative MRI is a valuable and reliable tool for accurately determining the boundaries of malignant bone tumors, which can be usefulin assessing long bone tumors before limb-sparing surgery.
Article Details
Keywords
Primary long malignant bone tumors, Tumor margin, Limb-Sparing surgery, Magnetic resonance imaging
References
2. Xu M, Wang Z, Yu X, Lin J, Hu Y. Guideline for Limb-Salvage Treatment of Osteosarcoma. Orthop Surg. 2020; 12(4): 1021-1029. doi:10.1111/os.12702.
3. Ahmad S, Stevenson J, Mangham C, Cribb G, Cool P. Accuracy of magnetic resonance imaging in planning the osseous resection margins of bony tumours in the proximal femur: based on coronal T1-weighted versus STIR images. Skeletal Radiol. 2014; 43(12): 1679-1686. doi:10.1007/s00256-014-1979-2.
4. Putta T, Gibikote S, Madhuri V, Walter N. Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours. Pol J Radiol. 2016; 81: 540-548. doi:10.12659/PJR.898108.
5. Thompson MJ, Shapton JC, Punt SE, Johnson CN, Conrad EU. MRI Identification of the Osseous Extent of Pediatric Bone Sarcomas. Clin Orthop. 2018; 476(3): 559-564. doi:10.1007/s11999.0000000000000068.
6. Jaffe N, Bruland OS, Bielack S, eds. Pediatric and Adolescent Osteosarcoma. 2010th edition. Springer; 2009.
7. Inarejos Clemente EJ, Navarro OM, Navallas M, et al. Multiparametric MRI evaluation of bone sarcomas in children. Insights Imaging. 2022; 13: 33. doi:10.1186/s13244-022-01177-9.
8. Jin Q, Xie X, Yao H, et al. Clinical Significance of the Radiological Relationship between the Tumor and the main blood vessels in Enneking IIB Osteosarcoma of the extremities. J Cancer. 2020; 11(11): 3235-3245. doi:10.7150/jca.42341.
9. jbstadmin. How important are surgical margins in Osteosarcoma? Journal of Bone & Soft Tissue Tumors. Published January 10, 2016. Accessed April 10, 2023. http://jbstjournal.com/important-surgical-margins-osteosarcoma/.
10. Gulia A, Puri A, Subi TS, Gupta SM, Juvekar SL, Rekhi B. Comparison of MRI and Histopathology with regard to Intramedullary Extent of Disease in Bone Sarcomas. Sarcoma. 2019; 2019: e7385470. doi:10.1155/2019/7385470.
11. Jin T, Deng ZP, Liu WF, Xu HR, Li Y, Niu XH. Magnetic Resonance Imaging for the Assessment of Long Bone Tumors. Chin Med J (Engl). 2017; 130(21): 2547-2550. doi:10.4103/0366-6999.217087.
12. Holzapfel K, Regler J, Baum T, et al. Local Staging of Soft-Tissue Sarcoma: Emphasis on Assessment of Neurovascular Encasement-Value of MR Imaging in 174 Confirmed Cases. Radiology. 2015; 275(2): 501-509. doi:10.1148/radiol.14140510.
13. White LM, Wunder JS, Bell RS, et al. Histologic assessment of peritumoral edema in soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 2005; 61(5): 1439-1445. doi:10.1016/j.ijrobp.2004.08.036.