Chondrosarcoma diagnostic study of choice: Difference between revisions

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__NOTOC__
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{{Chondrosarcoma}}
{{Chondrosarcoma}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{Rohan}}
 
== Overview ==
== 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 ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
*[[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>


OR
'''Prerequisites for a Biopsy'''
*[[Complete blood count|CBC]], [[Platelet|platelets]] and [[coagulation studies]] are required.
*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.
*The surgeon who performs [[biopsy]] should preferably be the one who is later going to do the final excision.


The following result of [gold standard test] is confirmatory of [disease name]:
'''Technique'''
* [Result 1]
*Open
* [Result 2]
*Closed


OR
===Open Technique===
*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===
===Incisional biopsy===
*A small surgical incision carefully placed to access [[tumor]] without contamination of critical structures.


[Name of the investigation] must be performed when:
===Excisional biopsy===
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
*it is done for small, superficial [[soft tissue]] masses.
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.


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


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


OR
'''Biopsy'''
*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.


The diagnostic study of choice for [disease name] is [name of the investigation].
''''Closure'''
*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]].


OR
===Closed Technique===


There is no single diagnostic study of choice for the diagnosis of [disease name].  
===Types===
===Fine Needle Aspiration (FNA)===
*It provides [[Cytological|cytologic]] specimen.
*It is the most commonly used for [[carcinoma]].
*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)=== 
*It allows for [[tumor]] structural examination.
*It allows evaluation of both the [[Cytological|cytologic]] and [[stromal]] elements of the [[tumor]].
*It is frequently used for [[sarcoma]].


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


There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
===Staging===
===Enneking (MSTS) Staging System===
*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.


OR
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
 
| valign="top" |
[Disease name] is primarily diagnosed based on the clinical presentation.
|-
 
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stages}}
OR
! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|Grade}}
 
! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|Site}}
Investigations:
! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|Metastasis}}
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
|-
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |IA
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | G1: Low grade
 
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | T1: Intracompartmental
==== The comparison of various diagnostic studies for [disease name] ====
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | M0: No metastasis
{|
|-
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |IB
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | G1: Low grade
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | T2: Extracompartmental
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | M0: No metastasis
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |IIA
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | G2: High grade
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | T1: Intracompartmental
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | M0: No metastasis
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |IIB
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | G2: High grade
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | T2: Extracompartmental
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | M0: No metastasis
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |III
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | G1 or G2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | T1 or T2
| style="padding: 5px 5px; background: #F5F5F5; font-weight: bold; text-align:center;" | M1: Regional or distant metastasis
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
'''IF there are no established diagnostic criteria'''
There are no established criteria for the diagnosis of [disease name].


==References==
==References==
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[[Category: Orthopedics]]
[[Category: Oncology]]
[[Category: Up-To-Date]]

Latest revision as of 18:11, 14 March 2019

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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.

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