A retrospective validation of an imaging protocol for the management of solitary central cartilage tumours of the proximal humerus and around the knee. Issue 12 (December 2019)

• Record Type: Journal Article
• Authors: Davies, A.M.; Patel, A.; James, S.L.; Botchu, R.
• Is Part Of: Clinical radiology. Volume 74:Issue 12(2019)
• Page Start: 962
• Page End: 971
• Publication Date: 2019-12
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2019.08.017
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : AIM: To validate an imaging protocol for the management of solitary central cartilage tumours (CCTs) of the proximal humerus and around the knee. MATERIALS AND METHODS: Over a 10-year period, 387 patients were identified with a CCT in the proximal humerus, distal femur, and proximal tibia, who were referred to a single unit either from primary/secondary care or tertiary care directly to Royal Orthopaedic Hospital, a specialist orthopaedic oncology service. The initial magnetic resonance imaging (MRI) images and any follow-up images were evaluated for length of tumour, presence/absence of endosteal scalloping, or aggressive/malignant features. The cases were categorised into one of seven types according to the Birmingham Atypical Cartilage Tumour Imaging Protocol (BACTIP). The outcome in the cases was assessed to ascertain if application of the protocol would have led to any delay in the diagnosis of malignant transformation to a chondrosarcoma. RESULTS: The incidence of malignancy (chondrosarcoma) increased with ascending BACTIP. There was a 100% benign diagnosis (enchondroma) in types IA and IB, 96% in IIA, and 83% in IIB. Fifty-seven percent of type IIC and 97% type III were diagnosed as malignant. In only one case would the application of the protocol have led to a 5-month delay in the diagnosis of chondrosarcoma. CONCLUSIONS: This retrospective study confirms the BACTIP as a useful tool for the general radiologist in the initial assessment of CCT in the proximal humerus and around the knee with the exception of the proximal fibula. In particular, determining which cases need prompt referral to a specialist orthopaedic oncology service for further assessment. Highlights: BACTIP is useful in the assessment of central cartilage tumours in the proximal humerus/around the knee. The incidence of malignancy (chondrosarcoma) increased with ascending BACTIP. BACTIP has a high inter and interobserver agreement. BACTIP can determine which cases need prompt referral to a specialist orthopaedic oncology service.