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BACKGROUND: Three Dimensional (3D) printed models can aid in effective pre-operative planning by defining the geometry of tumor mass, bone loss, and nearby vessels to help determine the most accurate osteotomy site and the most appropriate prosthesis, especially in the case of complex acetabular deficiency, resulting in decreased operative time and decreased blood loss. METHODS: Four complicated cases were selected, reconstructed and printed. These 4 cases were divided in 3 groups of 3D printed models. Group 1 consisted of anatomical models with major vascular considerations during surgery. Group 2 consisted of an anatomical model showing a bone defect, which was intended to be used for substantial instrumentation, pre-operatively. Group 3 consisted of an extra-compartmental bone tumor which displayed a deteriorated cortical outline; thus, using CT and MRI fused images to reconstruct the model accurately. An orthopedic surgeon created the 3D models of groups 1 and 2 using standard segmentation techniques. Because group 3 required complex techniques, an engineer assisted during digital model construction. RESULTS: These models helped to guide the orthopedic surgeon in creating a personalized pre-operative plan and a physical simulation. The models proved to be beneficial and assisted with all 4 cases, by decreasing blood loss, operative time and surgical incision length, and helped to select the appropriate acetabular supporting ring in complex acetabular deficiency, pre-operatively. CONCLUSION: Qualitatively, using 3D printing in tumor cases, provides personalized advantages regarding the various characteristics of each skeletal tumor.
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Giant cell tumor of the bones occurring in the first metacarpals frequently requires entire metacarpal resection due to the aggressive nature and high rate of recurrence. Bone reconstruction can be performed with autogenous bone grafts. Here we describe a new technique of reconstruction using a patient-matched three-dimensional printed titanium first metacarpal prosthesis. This prosthesis has a special design for ligament reconstruction in the proximal and distal portions. Good hand function and aesthetic appearance were maintained at a 24-month follow-up visit. This reconstructive technique can avoid donor-site complications and spare the autogenous bone grafts for revision options.
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BACKGROUND: The biopsy is a simple but critical step in the diagnosis of the musculoskeletal lesions. Although the open incisional biopsy traditionally has been considered the gold standard with high diagnostic accuracy, an alternative, the closed needle biopsy (CNB), has been developed and widely used as it can be performed at an outpatient clinic under local anesthesia or in combination with the image guidance. In the present study, the authors purpose to study the diagnostic accuracy of CNB without real-time image-guidance at an outpatient clinic by comparing it with open incisional biopsy in musculoskeletal sarcoma patients. MATERIAL AND METHOD: The authors retrospectively reviewed 200 biopsy cases of sarcoma patients since 2002-2011. There were 105 cases of open incisional biopsy 105 cases and 95 cases of CNB. The diagnostic accuracies of both mentioned methods were compared statistically in four aspects of histopathology: nature (benign or malignant), specific diagnosis, histological type and histological grade. The gold standard was afinal pathological diagnosis of the resected specimens receivedfrom definite surgery correlated with clinical findings and imnaging studies. RESULTS: The diagnostic accuracies of open incisional biopsy were 97.14% for nature, 89.52% for specific diagnosis, 89.52% for histological type, 88.57% for histological grade and the diagnostic accuracies of CNB were 96.84%, 89.47%, 88.42%, 86.32%, respectively. There was no significant statistical difference between the two methods in all histological aspects (p-value >0.05). The diagnostic yields of both methods were 98.13% for open incisional biopsy, 97.94% for CNB and there was no significant statistical difference (p-value >0.05). There were 6 cases (3%)for overall major errors, 3 cases (2.86%) firom open incisional biopsy and 3 cases (3.16%) from CNB. There were 18 cases (9%)for minor errors, 9 cases (8.57%) from open incisional biopsy and 9 cases (9.47%) from CNB. There was no biopsy related complication in either method. CONCLUSION: The office-based CNB diagnosis of musculoskeletal sarcoma can achieve an acceptably high diagnostic accuracy rate compared with open incisional biopsy.
Asunto(s)
Biopsia con Aguja/métodos , Neoplasias Óseas/patología , Osteosarcoma/patología , Neoplasias de los Tejidos Blandos/patología , Adulto , Instituciones de Atención Ambulatoria , Femenino , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
PURPOSE: The most important prognostic factor of osteosarcoma is the percentage of tumor necrosis. Only well trained and experienced musculoskeletal pathologists can count and assess the percentage of tumor necrosis from the resected specimens. The purpose of the present study was to characterize the correlation of Tc-99m MIBI scintigraphy for assessing the percentage of tumor necrosis using postoperative histology as a gold standard. MATERIAL AND METHOD: During September 2002 to August 2004, nine consecutive patients with the diagnosis of conventional osteosarcoma were included in the present study. The osteosarcoma protocol comprises 3 courses of doxorubicin and cisplatin preoperatively followed by wide resection of tumors and another 3 courses of postoperative chemotherapy. The Tc-99m MIBI scintigraphy examination was carried out before commencing chemotherapy and after completing preoperative chemotherapy. The tumor uptake was measured using the tumor to the background ratio (TBR). Comparison of TBR before and after preoperative chemotherapy was used to calculate the alteration ratio which was reported in terms of percentage. All of the resected specimens were sent to the pathological department. The histological assessment of the response to chemotherapy was performed using the standard technique according to the current practice of osteosarcoma from the Mayo Clinic. The percentages of tumor necrosis from histology were also reported. RESULTS: The analysis of the correlation between the reduction of tracer uptake and the postoperative histological response was performed. The correlation and linear regression analysis showed that the two methods had a significant correlation (R = 0.75) regression coefficient (1.172) with p = 0.020 and 0.043, respectively. CONCLUSION: The present study showed that Tc-99m MIBI scintigraphy had a significant correlation with percentage of tumor necrosis from histology. This technique can be used to predict the response of osteosarcoma after preoperative chemotherapy.