AI Article Synopsis
- The study focuses on how MRI is used to assess tumor extension in pediatric knee osteosarcomas, which is crucial for deciding surgical methods; however, interpreting MRI signals can be tricky due to inflammation and edema mimicking tumors.
- Researchers hypothesized that there is a gap between MRI results and histopathology findings when determining how much the joint is affected by osteosarcomas in kids.
- Results showed that nine patients underwent surgery based on certain MRI signs, but histopathology indicated that most of these surgeries (89%) could have been avoided, suggesting that specific MRI criteria for surgery need reevaluation for better accuracy.
Article Abstract
Introduction: The study of tumor extension in knee osteosarcomas is an essential diagnostic tool that helps determine the surgical approach. Magnetic resonance imaging (MRI) is the key component in this decision-making process, but the interpretation of signals can be difficult because peritumoral edema and inflammation may be mistaken for the tumor.
Hypothesis: There is a discrepancy between MRI and histopathology findings in the assessment of joint involvement in pediatric osteosarcomas of the knee.
Materials And Methods: All children who underwent an extra-articular resection for an osteosarcoma of the knee between 2007 and 2016 were included. This was indicated if there was at least one of the following MRI signs: presence of articular effusion, involvement of either the peripheral capsuloligamentous structures, central pivot or patella, or lesion abutting the articular cartilage.
Results: Nine patients were operated on with a mean age of 13±2.7 years. There were at least two of the described signs, mainly the involvement of the peripheral capsuloligamentous structures (78%) and central pivot (56%). The histopathology confirmed that the resection margins were healthy in all cases, but the indication for extra-articular resection could have been avoided in 89% of them.
Discussion: MRI is the current gold standard for assessing tumor extension, but the signs contraindicating the transarticular approach remain poorly defined. Joint effusion detected by clinical or radiological assessment is the least reliable one. It seems that the tumor's proximity to the articular cartilage, as long as there is no loss of continuity in the latter, or its extension into the central pivot should no longer be considered as relevant signs. The involvement of the peripheral capsuloligamentous structure remains an indication criterion because oncologic resection is otherwise impossible, and the risk of false-negative histopathologic diagnoses is higher. Other MRI sequences could better assess the true extension into the joint space.
Level Of Evidence: IV, retrospective study.
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| http://dx.doi.org/10.1016/j.otsr.2021.103086 | DOI Listing |
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