Chondrosarcoma diagnostic study of choice: Difference between revisions

Jump to navigation Jump to search
← Older edit
VisualWikitext
Rohan Bhimani (talk | contribs)
nocaptcha, Widget editors
1,101 edits
Farima Kahe (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators
4,723 edits
No edit summary
 
(3 intermediate revisions by one other user not shown)
Line 4: Line 4:


== Overview ==
== Overview ==
Biopsy is the gold standard test for the diagnosis of chondrosarcoma. Open biopsy is carried out for chonndrosarcoma. The tumor is then staged based on Enneking system for chondrosarcoma.
[[Biopsy]] is the gold standard test for the diagnosis of chondrosarcoma. Open [[biopsy]] is carried out for chondrosarcoma. The [[tumor]] is then staged based on Enneking system for chondrosarcoma.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
*Biopsy is the gold standard test for the diagnosis of chondrosarcoma. <ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref><ref>{{cite book | last = Czerniak | first = Bogdan | title = Dorfman and Czerniak's bone tumors | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2016 | isbn = 9780323023962 }}</ref>
*[[Biopsy]] is the gold standard test for the diagnosis of chondrosarcoma. <ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref><ref>{{cite book | last = Czerniak | first = Bogdan | title = Dorfman and Czerniak's bone tumors | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2016 | isbn = 9780323023962 }}</ref>


'''Prerequisites for a Biopsy'''
'''Prerequisites for a Biopsy'''
*CBC, platelets and coagulation studies
*[[Complete blood count|CBC]], [[Platelet|platelets]] and [[coagulation studies]] are required.
*Cross-sectional imaging to evaluate local anatomy such CT scan and MRI.
*Cross-sectional [[imaging]] to evaluate local anatomy such [[Computed tomography|CT scan]] and [[Magnetic resonance imaging|MRI]].
*Treatment center carrying out biopsy must be capable of proper diagnosis and treatment.
*Treatment center carrying out [[biopsy]] must be capable of proper [[diagnosis]] and treatment.
*The surgeon who performs biopsy should preferably be the one who is later going to do the final excision.
*The surgeon who performs [[biopsy]] should preferably be the one who is later going to do the final excision.


'''Technique'''
'''Technique'''
Line 22: Line 22:


===Open Technique===
===Open Technique===
*The tumor is surgically exposed and biospy of the tumor is taken.
*The [[tumor]] is surgically exposed and [[biopsy]] of the tumor is taken.
 
{| align="right"
|
[[File:Biopsy.jpg|300px|thumb| Open Biopsy.[https://commons.wikimedia.org/wiki/File:Brain_biopsy_under_stereotaxy.jpg Source: Case courtesy of Dake~commonswiki, via Wikimedia Commons]]]
|}
===Types===
===Types===
===Incisional biopsy===
===Incisional biopsy===
*A small surgical incision carefully placed to access tumor without contamination of critical structures
*A small surgical incision carefully placed to access [[tumor]] without contamination of critical structures.


===Excisional biopsy===
===Excisional biopsy===
*it is done for small, superficial soft tissue masses.
*it is done for small, superficial [[soft tissue]] masses.


'''Incision'''
'''Incision'''
*Longitudinal incision in the extremities is taken.
*Longitudinal [[incision]] in the [[extremities]] is taken.
*It should allow for extension of the incision for definitive management
*It should allow for [[extension]] of the [[incision]] for definitive management.


'''Approach'''
'''Approach'''
*Never expose neurovascular structures.
*Never expose [[Neurovascular bundle|neurovascular]] structures.
*During the biopsy, all tissue exposed is considered contaminated with tumor.  
*During the [[biopsy]], all tissue exposed is considered contaminated with [[tumor]].  
*Meticulous hemostasis to be carried out.
*Meticulous [[hemostasis]] to be carried out.
*Post-surgery hematomas are considered contaminated with tumor.
*Post-surgery [[Hematoma|hematoma']]<nowiki/>s are considered contaminated with tumor.
*Always deflate the tourniquet prior to wound closure.
*Always deflate the [[tourniquet]] prior to wound closure.


'''Biopsy'''
'''Biopsy'''
*Perform through the involved compartment of the tumor.
*Perform through the involved [[Compartment (anatomy)|compartment]] of the [[tumor]].
*For bone lesions with a soft tissue mass, perform the biopsy using the soft tissue mass.
*For [[bone]] lesions with a [[soft tissue]] mass, perform the [[biopsy]] using the soft tissue mass.


'''Closure''
''''Closure'''
*If drain is kept, remove the drain out of the skin in line with surgical incision.
*If [[Drain (surgery)|drain]] is kept, remove the [[Drain (surgery)|drain]] out of the skin in line with surgical [[incision]].
*This helps in excising the drain site with definitive surgical extensile incision.
*This helps in excising the drain site with definitive surgical extensile [[incision]].


===Closed Technique===
===Closed Technique===
Line 54: Line 57:
===Types===
===Types===
===Fine Needle Aspiration (FNA)===
===Fine Needle Aspiration (FNA)===
*It provides cytologic specimen.
*It provides [[Cytological|cytologic]] specimen.
*It is the most commonly used for carcinoma.
*It is the most commonly used for [[carcinoma]].
*It is usually not preferred for sarcoma
*It is usually not preferred for [[sarcoma]].
 
{| align="right"
|
[[File:Needle biopsy.jpg|300px|thumb| Needle Biopsy.[https://upload.wikimedia.org/wikipedia/commons/0/02/Needle_biopsy.jpg Source: Case courtesy of Linda Bartlett (photographer) [Public domain], via Wikimedia Commons]]]
|}
===Core biopsy (Tru-cut Biopsy)===   
===Core biopsy (Tru-cut Biopsy)===   
*It allows for tumor structural examination.
*It allows for [[tumor]] structural examination.
*It allows evaluation of both the cytologic and stromal elements of the tumor.requently used for sarcoma  
*It allows evaluation of both the [[Cytological|cytologic]] and [[stromal]] elements of the [[tumor]].
Incisional biopsy
*It is frequently used for [[sarcoma]].
small surgical incision carefully placed to access tumor without contamination of critical structures
Excisional biopsy
select indications: small, superficial soft tissue masses


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The various investigations must be performed in the following order:
The various investigations must be performed in the following order:
*X-ray
*[[X-rays|X-ray]]
*MRI
*[[MRI]]
*Biopsy
*[[Biopsy]]


===Staging===
===Staging===
===Enneking (MSTS) Staging System===
===Enneking (MSTS) Staging System===
*The Enneking surgical staging system (also known as the MSTS system) for malignant [[Musculoskeletal system|musculoskeletal]] [[Tumor|tumors]] based on histological and [[radiographic]] characteristics of the tumor host margin.<ref name="pmid20333492">{{cite journal| author=Jawad MU, Scully SP| title=In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system. | journal=Clin Orthop Relat Res | year= 2010 | volume= 468 | issue= 7 | pages= 2000-2 | pmid=20333492 | doi=10.1007/s11999-010-1315-7 | pmc=2882012 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20333492  }} </ref><ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
*The Enneking surgical staging system (also known as the MSTS system) for malignant [[Musculoskeletal system|musculoskeletal]] [[Tumor|tumors]] based on [[Histology|histological]] and [[radiographic]] characteristics of the [[tumor]] host margin.<ref name="pmid20333492">{{cite journal| author=Jawad MU, Scully SP| title=In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system. | journal=Clin Orthop Relat Res | year= 2010 | volume= 468 | issue= 7 | pages= 2000-2 | pmid=20333492 | doi=10.1007/s11999-010-1315-7 | pmc=2882012 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20333492  }} </ref><ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
*It is widely accepted and routinely used staging system.
*It is widely accepted and routinely used staging system.


Latest revision as of 18:11, 14 March 2019

Chondrosarcoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chondrosarcoma from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiography and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Chondrosarcoma diagnostic study of choice On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Chondrosarcoma diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chondrosarcoma diagnostic study of choice

CDC on Chondrosarcoma diagnostic study of choice

Chondrosarcoma diagnostic study of choice in the news

Blogs on Chondrosarcoma diagnostic study of choice

Directions to Hospitals Treating Chondrosarcoma

Risk calculators and risk factors for Chondrosarcoma diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Biopsy is the gold standard test for the diagnosis of chondrosarcoma. Open biopsy is carried out for chondrosarcoma. The tumor is then staged based on Enneking system for chondrosarcoma.

Diagnostic Study of Choice

Study of choice

  • Biopsy is the gold standard test for the diagnosis of chondrosarcoma. [1][2]

Prerequisites for a Biopsy

Technique

  • Open
  • Closed

Open Technique

  • The tumor is surgically exposed and biopsy of the tumor is taken.
Open Biopsy.Source: Case courtesy of Dake~commonswiki, via Wikimedia Commons

Types

Incisional biopsy

  • A small surgical incision carefully placed to access tumor without contamination of critical structures.

Excisional biopsy

Incision

Approach

  • Never expose neurovascular structures.
  • During the biopsy, all tissue exposed is considered contaminated with tumor.
  • Meticulous hemostasis to be carried out.
  • Post-surgery hematoma's are considered contaminated with tumor.
  • Always deflate the tourniquet prior to wound closure.

Biopsy

'Closure

  • If drain is kept, remove the drain out of the skin in line with surgical incision.
  • This helps in excising the drain site with definitive surgical extensile incision.

Closed Technique

Types

Fine Needle Aspiration (FNA)

Needle Biopsy.Source: Case courtesy of Linda Bartlett (photographer) [Public domain, via Wikimedia Commons]

Core biopsy (Tru-cut Biopsy)

Sequence of Diagnostic Studies

The various investigations must be performed in the following order:

Staging

Enneking (MSTS) Staging System

Stages Grade Site Metastasis
IA G1: Low grade T1: Intracompartmental M0: No metastasis
IB G1: Low grade T2: Extracompartmental M0: No metastasis
IIA G2: High grade T1: Intracompartmental M0: No metastasis
IIB G2: High grade T2: Extracompartmental M0: No metastasis
III G1 or G2 T1 or T2 M1: Regional or distant metastasis

References

  1. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  2. ↑ Czerniak, Bogdan (2016). Dorfman and Czerniak's bone tumors. Philadelphia, PA: Elsevier/Saunders. ISBN 9780323023962.
  3. ↑ Jawad MU, Scully SP (2010). "In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system". Clin Orthop Relat Res. 468 (7): 2000–2. doi:10.1007/s11999-010-1315-7. PMC 2882012. PMID 20333492.
  4. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Chondrosarcoma_diagnostic_study_of_choice&oldid=1558164"