Enchondroma versus Low-Grade Chondrosarcoma in Appendicular Skeleton: Clinical and Radiological Criteria

Objectives. To determine the validity of clinical and radiological features of enchondroma and low grade chondrosarcoma, and contrast the biopsy results with the clinical diagnosis based on the history and imaging. Material and Method. The study included 96 patients with cartilage type lesions suggestive of an enchondroma (E) or an low grade chondrosarcoma (LGC) according to the clinical and imaging data. The hypotheses were contrasted with the biopsy. Results. Of the 82 patients studied completely, 56 were considered E (68.29%), 8 as LGC (8.33%) and in 18 (18.75%) were doubtful cases and considered as suspected LGC. Of these, the biopsy showed 4？E (25%), 10？LGC (50%) and 4 were not definitive. On the other hand, of the 56 cases diagnosed as E, 15 were biopsied, 5 of these biopsies turned out to be LGC (33.3%). The 8 cases diagnosed as LGC, were also biopsied and only 4 biopsies (50%) confirmed the initial diagnosis. Features analyzed in the study showed no statistically significant difference. Correlation analysis between the diagnosis issued initially and the biopsy result gave a value of 0.69 (kappa coefficient), which was considered a good correlation. Conclusion. Features analyzed did not have any statistical significance. However, there was a good correlation between initial diagnosis and biopsy's result. 1. Introduction Bone tumors diagnosis includes many radiological, epidemiological, pathological, and clinical considerations. Those including patient questioning, physical examination, and radiology will give some hints towards the final diagnosis. But, most of the time, a specimen must be obtained in order to guarantee an accurate confirmation. However, in some cases, it is not easy to decide what kind of malignancy we are treating even with a biopsy. It is in those situations that clinical and radiological data become extremely important when making a decision on treatment strategies. Among cartilage tumors, two entities can be misleading for the pathologist when trying to reach a correct diagnosis: enchondroma (E), a benign tumor, and low grade chondrosarcoma (LGC), which is a low-aggressivity malignancy. This can be a problem when deciding treatment because E only requires regular followup but LGC needs surgical treatment. The goals of the present study are first, to determine the existence of statistical significance between clinical and radiological criteria (obtained from physical examination, plain radiographs, computerized tomography (CT), magnetic resonance (MRI), bone scan with Tc99) and biopsy results; secondly, to find the