CORRInsights®: Do Orthopaedic Oncologists Agree on the Diagnosis and Treatment of Cartilage Tumors of the Appendicular Skeleton?

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Hyaline cartilage tumors are so common that some orthopaedic oncologists view them as the “low back pain” of orthopaedic oncology. Though observed frequently, distinguishing between benign enchondroma and a low-grade chondrosarcoma is a challenge for orthopaedic oncologists. Which ones need treatment? Which ones can be observed?
These questions are difficult to answer because orthopaedic oncologists lack a gold standard for diagnosing this common tumor. Radiology and histology are not foolproof. Numerous papers have shown difficulty in distinguishing these tumors by radiologic means alone [1, 5], and unlike other neoplasms, biopsy of hyaline cartilage tumors rarely provide a conclusive diagnosis, making it difficult for pathologists and radiologists to recommend a definitive treatment option. This was eloquently demonstrated by the Skeletal Lesions Interobserver Correlation among Expert Diagnosticians (SLICED) study group [4], which showed that even experienced pathologists and radiologists had low reliability in distinguishing benign versus malignant hyaline cartilage tumors, let alone the grade of malignant ones.
In the current study, Zamora and colleagues show that expert orthopaedic oncologists using clinical information and radiology studies barely have fair interobserver agreement in grading intramedullary extremity hyaline cartilage tumors.
With this as background, the argument could be made that radiologists, pathologists, and orthopaedic oncologists do not have a great handle on what to do with these tumors.
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