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. 2021 Aug;56(4):411-418.
doi: 10.1055/s-0040-1710331. Epub 2020 Sep 30.

Updating on Bone and Soft Tissue Sarcomas Staging

Alex Guedes  1 , Marcelo Bragança Dos Reis Oliveira  2 , Flávia Martins Costa  3 , Adelina Sanches de Melo  4
Affiliations

Updating on Bone and Soft Tissue Sarcomas Staging

Alex Guedes et al. Rev Bras Ortop (Sao Paulo). 2021 Aug.

Abstract

Bone and soft tissue sarcomas consist of a heterogeneous group of malignant tumors of mesenchymal origin that can affect patients from any age. The precise staging of these lesions determines the best therapeutic strategies and prognosis estimates. Two staging systems are the most frequently used: the system proposed by the University of Florida group, led by Dr. William F. Enneking (1980) and adopted by the Musculoskeletal Tumor Society (MSTS), and the system developed by the American Joint Committee on Cancer (AJCC) (1977), currently in its 8 th edition (2017). This paper updates the reader on the staging of bone and soft tissue sarcomas affecting the musculoskeletal system.

Keywords: diagnostic imaging; neoplasm staging; neoplasms, bone tissue; neoplasms, connective tissue; pathology, surgical; sarcoma.

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Conflict of interest statement

Conflito de Interesses Os autores declaram não haver conflito de interesses.

Figures

Fig. 1
Fig. 1
Algorithm for initial evaluation and imaging staging of suspected bone and soft tissue sarcomas.
Fig. 2
Fig. 2
Conventional calcaneal osteosarcoma. ( A ) Lateral radiography showing calcaneal lytic and sclerotic areas. ( B ) Sagittal magnetic resonance imaging in T1-weighted sequence showing diffuse hyposignal in the calcaneus with no extracompartmental tumor. ( C ) Surgical approach for calcaneus resection. Musculoskeletal Tumor Society (MSTS) staging, IA; American Joint Committee on Cancer (AJCC) staging, IIA.
Fig. 3
Fig. 3
High-grade pleomorphic sarcoma at the right knee. Proton density sequences with fat suppression in the sagittal plane before treatment ( A ) showing a heterogeneous lesion in the posterior compartment. Axial dynamic study ( B ) and color map ( C ) showing early enhancement in the posterior and superficial portion of the lesion (red line in D ). Five months after treatment, a conventional magnetic resonance imaging does not show a significant change in lesion signal intensity ( E ). However, the dynamic axial study ( F ) and color map ( G ) show a change in the pattern of lesion enhancement (red line in H ), indicating good therapeutic response. Histological analysis showed more than 90% of tumor necrosis. American Joint Committee on Cancer (AJCC) staging, IIIA.
Fig. 1
Fig. 1
Algoritmo para avaliação inicial e estadiamento por imagens das suspeitas de sarcomas ósseos e das partes moles.
Fig. 2
Fig. 2
Osteossarcoma convencional no calcâneo. ( A ) radiografia em perfil mostrando áreas líticas e escleróticas no calcâneo ( B ) corte sagital de ressonância magnética com sequência ponderada em T1 evidenciando hipossinal difuso no calcâneo sem tumor extracompartimental ( C ) via de acesso para ressecção do calcâneo. Estadiamento MSTS IA, AJCC IIA.
Fig. 3
Fig. 3
Sarcoma pleomórfico de alto grau no joelho direito. Sequências em densidade protônica com supressão de gordura no plano sagital antes do tratamento ( A ) demonstrando lesão heterogênea no compartimento posterior. Estudo dinâmico axial ( B ) e mapa colorido ( C ) demonstrando realce precoce na porção posterior e superficial da lesão (linha vermelha em D ). Cinco meses após o tratamento, a ressonância magnética convencional não evidencia mudança significativa na intensidade de sinal da lesão ( E ). Entretanto, o estudo dinâmico axial ( F ) e mapa colorido ( G ) evidenciam mudança no padrão do realce da lesão (linha vermelha em H ), indicando boa resposta ao tratamento. Análise histológica evidenciou mais de 90% de necrose tumoral. Estadiamento AJCC IIIA.
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