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FNA（fine needle aspiration）：癌及淋巴結細胞學檢查，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切除活檢原則使用病變累及的間室不要顯露NV 結構切口可延伸并與預計手術切口方向一致避免手觸及切口內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: 內側？外側？前側？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