Usefulness of radiography in differentiating enchondroma from central grade I chondrosarcoma
Usefulness of radiography in differentiating enchondroma from central grade I chondrosarcoma
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DOI：
10.2214/ajr.169.4.9308471
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发表时间：
1997-10-01
影响因子：
5
通讯作者：
Hogendoorn, PCW
中科院分区：
文献类型：
--
作者：
Geirnaerdt, MJA;Hermans, J;Hogendoorn, PCW
OBJECTIVE.本研究的目的是评估临床症状和放射学特征，使放射科医生区分内生软骨瘤和中央1级软骨肉瘤，这种分化是重要的，因为在管理的差异。分析35例内生软骨瘤和43例中央1级软骨肉瘤的临床症状、部位和大小。影像学特征由三名观察员独立评估。采用卡方检验和线性判别分析确定具有判别强度的特征。计算Kappa值以验证观察者之间观察结果的一致性。组织学和长期随访的一致诊断被用作标准。临床症状与肿瘤的良性或恶性性质之间无统计学显著相关性。1级软骨肉瘤更容易在中轴骨和扁骨中发现。而且，软骨肉瘤明显大于内生软骨瘤（p <0.001）。边界不清和分叶状轮廓是X线片上唯一允许显著区分的形态学特征（分别为p = 0.004和0.009）。四个放射学特征的最佳组合仍然留下78个病变中的72个具有10-90%的恶性概率，表明鉴别力差。Kappa值通常显示较差至一般的一致性。中轴骨的位置和大于5cm的大小是中央1级软骨肉瘤最可靠的预测因子。影像学上的形态学特征和临床症状并不能提高内生软骨瘤和中央1级软骨肉瘤的鉴别能力。
OBJECTIVE. The purpose of this study was to evaluate clinical symptoms and radiographic features that allow radiologists to differentiate between enchondroma and central grade 1 chondrosarcoma Such differentiation is important because of differences in management.MATERIALS AND METHODS. Clinical symptoms and location and size of 35 enchondromas and 43 central grade 1 chondrosarcomas were analyzed. Radiographic features were assessed independently by three observers. The chi-square test and linear discriminant analysis were used to identify features with discriminating strength. Kappa values were calculated to validate the consistency of observations among observers. A consensus diagnosis made by histology and long-term follow-up was used as the standard.RESULTS. No statistically significant correlation was found between clinical symptoms and the benign or malignant nature of the neoplasms. Grade 1 chondrosarcomas were more likely to be found in the axial skeleton and in flat bones. Also, chondrosarcomas were significantly larger than enchondromas (p < .001). Ill-defined margins and lobulated contours were the only morphologic features seen on radiographs that allowed significant discrimination (p = .004 and .009, respectively). An optimal combination of four radiographic features still left 72 of the 78 lesions with a 10-90% probability of malignancy, indicative of poor discriminating power. Kappa values generally showed poor to fair agreement.CONCLUSION. Location in the axial skeleton and size greater than 5 cm are the most reliable predictors of central grade 1 chondrosarcoma. Morphologic features seen on radiographs and clinical symptoms do not improve the ability to differentiate between enchondromas and central grade 1 chondrosarcomas.