Xiaohui Niu

Pulmonary metastasis of giant cell tumor of bones

Giant cell tumor of bone (GCTB) accounts for 5% of primary skeletal tumors. Although it is considered to be a benign lesion, there are still incidences of pulmonary metastasis. Pulmonary metastasis of GCTB may be affected by tumor grading and localization as well as the age, gender and overall health status of the patient. Patients with local recurrence are more likely to develop pulmonary metastasis of GCTB. High expression of some genes, cytokines and chemokines may also be closely related to the metastatic potential and prognosis of GCTB. The treatment of the primary GCTB is key to the final outcome of the disease, as intralesional curettage has a significantly higher local recurrence and pulmonary metastasis rate than wide resection. However, even patients with pulmonary metastasis seem to have a good prognosis after timely and appropriate surgical resection. It is hoped that with the development of novel surgical methods and drugs, pulmonary metastasis of GCTB can be prevented and treated more effectively.

Positron emission tomography/computed tomography for bone tumors (Review)

The aim of the present study was to investigate positron emission tomography (PET)/computed tomography (CT) and its applications for the diagnosis and treatment of bone tumors. The advantages and disadvantages of PET/CT were also evaluated and compared with other imaging methods and the prospects of PET/CT were discussed. The PubMed, Medline, Elsevier, Wanfang and China International Knowledge Infrastructure databases were searched for studies published between 1995 and 2013, using the terms ‘PET/CT’, ‘positron emission tomography’, ‘bone tumor’, ‘osteosarcoma’, ‘giant cell bone tumor’ and ‘Ewing sarcoma’. All the relevant information was extracted and analyzed. A total of 73 studies were selected for the final analysis. The extracted information indicated that at present, PET/CT is the imaging method that exhibits the highest sensitivity, specificity and accuracy. Although difficulties and problems remain to be solved, PET/CT is a promising non-invasive method for the diagnostic evaluation of and clinical guidance for bone tumors.

Treatment for giant cell tumor of the spine metastasizing to the lung: A report of two cases and a literature review.

Giant cell tumors of the bone (GCTB) account for 5% of all primary skeletal tumors. Although the tumors are normally benign, recurrence and metastasis of GCTB does occur. The most usual sites of a primary GCTB lesion are the distal femur and proximal tibia, and ~3% of these metastasize to the lung. Primary GCTB lesions in the spine are rare, and there have been few cases reporting the pulmonary metastasis of GCTB in the spine. The present study reports two cases of thoracic and sacral spinal GCTB lesions with pulmonary metastasis. One of the patients was a 45-year-old male who presented to hospital with gradually worsening pain in the left buttock during the last two years and was diagnosed with GCTB of the sacrum. The other patient was a 30-year-old female who complained of persistent back pain for a year and was also diagnosed with GCTB of the sacrum. Arterial embolization was performed prior to surgery and computer navigation was used during the surgery, resulting in the two patients achieving en bloc resection of their respective tumors, with satisfactory rehabilitation to follow.

Diagnosing giant cell tumor of the bone using positron emission tomography/computed tomography: A retrospective study of 20 patients from a single center

The aim of the present study was to evaluate the sensitivity of positron emission tomography/computed tomography (PET/CT) in the diagnosis of giant cell tumor of the bone (GCTB) using the maximum standard uptake value (SUVmax), which indicates the metabolic rate of tissue. Patients diagnosed with pathologically confirmed GCTB between January 2006 and July 2015 were included in the study. Data from PET/CT scans and pathological and clinical reports for all patients were retrospectively reviewed. The SUVmax value from the PET/CT scan of each patient was retrieved and analyzed. A total of 20 patients [12 male and 8 female; age range, 12–45 years; mean age ± standard deviation (SD), 33.5±15.7] with complete PET/CT data and a pathologically and clinically confirmed diagnosis were examined. The SUVmax of GCTB was between 1.8 and 18.6, with a mean ± SD of 9.2±3.8. Although GCTB is not considered to be a malignant lesion, PET/CT scans of the tumors reveal high-grade malignant osseous sarcomas. It is, therefore, important not to mistake such lesions for osteosarcomas or metastatic malignancies of the bone.

Deficiencies in the Diagnosis and Treatment of Pulmonary Metastatic Osteosarcoma: A Chinese Multidisciplinary Survey

BACKGROUND AND OBJECTIVE Osteosarcoma is the most frequent primary cancer of bone. The incidence is higher in adolescents. Large improvement, though, has been made in the treatment of osteosarcoma under the framework of multidisciplinary team, an important prognostic factor for osteosarcoma is pulmonary metastasis. Surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. Undoubtedly, surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. However, since current conceptions within the surgical approach to lung metastasectomy involve multidisciplinary collaboration, which are highly variable,there is not neither consensus nor standardized practice patterns. We conduct a survey aiming to reveal areas of consistency in current clinical practice on lung metastasectomy among Chinese osteosarcoma high volume centers. METHODS A questionnaire survey specific to the nationwide high volume centers of osteosarcoma was conducted from September 2015 to November 2015. Analyses were stratified by hospital, working duration, case volume and medical discipline. RESULTS Of 150 invited physicians, 105 participated, resulting in an overall response rate of 70%. Forty-one percent of the responded physicians agreed with the statement that orthopedic oncology should play a predominant role in the multidisciplinary team. More than 64% of respondents chose metastasectomy as the preferred local control approach, and up to 78.1% of respondents recommended pulmonary metastasectomy for patients. Compared with orthopedic surgeons, other physicians were significantly more likely to report not advocating pulmonary metastasectomy in their practice (OR(others)=0.02; 95%CI: 0.00-0.22; P=0.001), and thoracic surgeons were more likely to decide metastasectomy according to indications rather than the number limit of metastases (OR(thoracic surgeons)=20.93; 95%CI: 2.05-213.64; P=0.001). For the most preferred radiographic evaluation option, approximately 83% of respondents reported diagnostic use of computed tomography (CT). More than 70% of respondents reported that chest CT follow-up should be 3 months after the primary site resection; approximately 68% deemed the diagnostic accuracy of CT about 90%; most respondents (92%) recommended the extrapulmonary imaging evaluation simultaneously. Around 46% of respondents reported that survival duration longer than 6 months after pulmonary metastasectomy is beneficial. CONCLUSION This study offers new information about the variability in the reported management of pulmonary metastatic osteosarcoma in China, reflecting the deficiencies in unified practice patterns. The results of this survey also provide baseline data for future research and for the development of international guidelines.

Analysis of the coincidence rate between imaging and pathological findings of pulmonary metastasis in 45 cases with invasive bone and soft tissue sarcoma

It is not uncommon for imaging examinations of invasive bone and soft tissue sarcoma patients during initial treatment or postoperative follow‐up to detect pulmonary nodules. This has important significance in determining the nature of nodules either for tumor staging and therapeutic regimen selection or for prognosis evaluation.

Microwave Ablation for Bone Tumors

Microwave ablation is a technique which achieves tumor ablation by turning the ultrahigh frequency microwave energy into heat in the center of target tissue where the antenna was located. Microwave ablation can produce fast and well-distributed heat and causes necrosis in the tumor tissue. It is a micro invasive surgical method which can be applied in the treatment of a variety of tumors. It has several advantages comparing with other complementary methods for the treatment of tumor. For example, microwave ablation requires little cost, effectively prevents the metastasis of tumor cells, requires shorter time for hospital stay and helps keeping the integrity of the structure of the bone with tumor, which is essential for preserving the function of the limb after the surgery. However, it may also increase the incidence of pathologic fracture, cause nerve injury and poor wound healing. Appropriate output of energy and frequency of microwave, appropriate temperature in the center and surface of tumor as well as well manipulation of several antennas on large tumors can effectively eliminate the treatment related complications and achieve more satisfying results after the surgery. Microwave ablation is a minimally invasive technique, which causes coagulation necrosis by rising the temperature with deposition of electromagnetic energy to a critical level of around 60. Microwave ablation can be applied as a complementary method for the treatment of tumors. It has already been used for the treatment of liver, gastrointestinal, cerebral, renal, lung and musculoskeletal tumors. In this paper, we made a review on the mechanisms, advantages, applications, and challenges for the microwave ablation in musculoskeletal tumor therapy.