骨和軟組織腫瘤診治基礎課件

1、骨與軟組織腫瘤診治原則301醫(yī)院骨腫瘤科 賈金鵬原則的重要性骨腫瘤核心知識診斷切除理念活檢Jaffe ：A biopsy should be regarded as the final diagnostic procedure, not as a mere short cut to diagnosis活檢1982, Mankin 329 patients errors in diagnosis was 18.2%complications was 17.3%Unnecessary amputations were performed in 4.5%. 2019, Mankin 597 pati

2、ents errors in diagnosis in 13.5%Complication rate 15.9unnecessary amputations in 3%.In addition to technical recommendations, it was recommended that if a surgeon or an institution is not equipped to perform accurate diagnostic studies or definitive surgery and adjunctive treatment of musculoskelet

3、al tumors, the patient should be referred to a specialized treating center before the biopsy is performed.活檢活檢指征:如有疑問= 活檢任何有惡性征象的病變均需活檢良性侵襲性病變，不能完全確定時其他器官腫瘤，出現(xiàn)孤立性骨破壞穿刺條件:有經(jīng)驗的骨與軟組織腫瘤方面的病理科醫(yī)生協(xié)作團隊能指導穿刺的影像學檢查穿刺不能取代完善的病史/查體/實驗室檢查及影像學檢查穿刺技術(shù)FNA（fine needle aspiration）：癌及淋巴結(jié)細胞學檢查，診斷肉瘤困難Core：選取有代表性的部分活檢透視或CT

4、引導Incisional 切取代表性組織，不帶來更多污染機會Excisional 小并表淺的病變隨手術(shù)切除活檢原則使用病變累及的間室不要顯露NV 結(jié)構(gòu)切口可延伸并與預計手術(shù)切口方向一致避免手觸及切口內(nèi)組織盡量使用止血帶并在關閉切口前松止血帶如需引流，引流出口與切口方向一致具體活檢方法選擇表淺 5 cm = 分期 + 活檢位于骨表面= 分期 + 活檢深部病變=分期 + 活檢常見區(qū)域肱骨頭: 股骨遠端: 內(nèi)側(cè)？外側(cè)？前側(cè)？Staging Primary bone tumors Subdivided into : - benign bone neoplasm - latent - active -

5、aggressive - malignant bone neoplasm - low grade - high grade Benign latent Intracpsular Asymptomatic Incidental finding Xrays: - well defined margins - no cortical destruction e.g non ossifying fibroma , enchondroma , osteochondromaBenign active Intracpsular Actively growing Symptomatic Pathologica

6、l fractureXrays: - well defind margins - expansile and may thin the cortex e.g : Unicameral bone cyst , osteiod osteoma Benign aggressive SymptomaticRisk of mets is around 5% Xrays - aggresvise nature - destruction of the cortex - new cortix formation MRI may show a soft tissue mass e.g : Gaint cell

7、 tumors , aneurysmal bone cyst Malignant lesions (Enneking )Low grade tumors are designated as stage 1 - low risk of mets ( 25% ) hist: well differentiated , few mitoses and moderate cytological atypia .High grade tumors are designated as stage 2 - high risk of mets hist: poorly differentiated .Meta

8、stases stage 3Compartmentsintra-osseousintra-articularsuperficial to fasciaparosseousintra-fascial compartmentanatomic regions contained by natural barriers to tumor extensionCompartmentsneurovascular bundlespara-articular tissuesaxilla / antecubital fossagroin / popliteal fossahand/footEXTRACOMPARTMENTAL SITESHow To Stage Bone TumorsBenign Latent/Active: Local - xray +/- CT/MRI +/- TBBSBenign Aggressiv