2. Assessment of interobserver variability and histological parameters to improve. central cartilaginous tumours.

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1 . Assessment of interobserver variability and histological parameters to improve central cartilaginous tumours. Daniel Eefting, Yvonne M. Schrage, Maartje J. Geirnaerdt, Saskia Le Cessie, Antonie H.M. Taminiau, Judith V.M.G. Bovée, Pancras C.W. Hogendoorn; Eurobonet consortium. Am J Surg Pathol 009;33:0-7

2 Chapter Abstract 0 enchondromas and 37 central grade I chondrosarcomas diagnosed in a. to differentiate enchondroma from central grade I chondrosarcoma. We the diagnosis of cartilaginous tumours. 3

3 Interobserver variability in chondrosarcoma Introduction. 3- and peripheral chondrosarcomas are recognised, the latter developing malignant progression in peripheral chondrosarcomas. For the differential diagnosis central chondrosarcoma versus enchondroma these parameters microscopical level. chondrosarcoma 9,. As a grade I chondrosarcomas remains important. differential diagnosis. Several histopathological features are used to differentiate central grade 33

4 Chapter value of individual morphologic criteria in differentiating enchondroma from central grade I chondrosarcomas and investigated their diagnostic power Materials and Methods Cases to study interobserver variability. Patient age and location of the tumour were provided, together with pre-operative radiographs, Age Location 3 Femur Femur Distal femur Table.1 Patients to study interobserver variability. Information as provided to the pathologists.

5 Interobserver variability in chondrosarcoma Cases to study histological criteria detailed follow-up including adequate radiological follow-up documentation. a protracted clinical course with almost no metastases despite ominous Histopathology literature the resected specimen as discussed in the aforementioned panel was used Statistical Analysis Interobserver variability 3

6 Chapter Figure.1 Light-micrographs displaying the morphologic parameters shown to be of diagnostic value - Histological criteria values for enchondroma or low-grade chondrosarcoma were computed for different diagnostic parameters. The Chi-square test was used to compare and forward stepwise enchondroma from central grade I chondrosarcoma. Logistic regression enchondroma from central grade I chondrosarcoma.

7 Interobserver variability in chondrosarcoma Results Assessment of interobserver variability Assessment of histological criteria to distinguish enchondroma vs grade I chondrosarcoma Figure. 37

8 Chapter Spontaneous pain Acromion Femur Ileum Scaphoid Scapula Spine Sternum Ulna No. No P-value 0.00* Table. Clinical details, localisation and age at presentation of the 7 patients to study histological criteria. Slight differences in the anatomical localisation of enchondromas and

9 Interobserver variability in chondrosarcoma Chondrosarcomas No. No. P-value Cytology Slight Condensed nuclei Present Open chromatin Present Present Histology * 0.000* 30.0 Present Present Present Present Present * 0.000* * Table.3 Cytological and architectural parameters scored on biopsy specimens of the 7 patients, with either enchondroma or grade I central chondrosarcoma. 39

10 Chapter Figure.3: Light-micrograph, - pathologists and as a malignant pathologists.

11 Interobserver variability in chondrosarcoma Chondroid Chondrosarcomas No. No Table.4. Morphologic matrix quality of enchondromas and chondrosarcomas. P-value 0.000* 0.000* 0.00* from central grade I chondrosarcoma. An increase of chondroid structure clinico-radiological follow-up and used as gold standard compared to the chondrosarcomas.

12 Chapter up Chondrosarcomas Total Diagnosis of the actual histological evaluation* Chondrosarcomas 33 3 Total Table.. Histopathological assessment compared with the consensus diagnosis after ten years of follow-up. Discussion that the diagnosis and histological grading of cartilaginous tumours is This distinction is important to guide surgical management. While an enchondromas cartilaginous tumours were advocated in the past, although the tumours to assess the value of histomorphological criteria and clinical of these in predicting a correct diagnosis. The diagnosis of these tumours

13 Interobserver variability in chondrosarcoma pathologic features. 3. Sampling errors however could give false predicting results when interpreted without detailed knowledge of the radiological presentation. an enchondroma. instead of histological grading as a measurement for outcome in molecular studies searching for prognostic parameters of chondrosarcoma. chondrosarcoma, the distinction with grade II chondrosarcoma is essential

14 Chapter grounds alone. Therefore, when the radiological assessment of a Acknowledgements The authors like to thank the specialised panellists that participated in the B. Bjerkehagen, References for targeted treatment. Lancet Oncol the literature. Diagn Imag Clin Med point to a diverging genetic mechanism in the origin of peripheral and central chondrosarcoma. Genes Chrom Cancer

15 Interobserver variability in chondrosarcoma of osteochondroma towards peripheral chondrosarcoma and is a late event in central chondrosarcoma. Lab Invest of peripheral chondrosarcoma in a clinicopathological setting. Virchows Arch Clin Orthop grade I chondrosarcoma. A J R Clinical Orthopaedics and Related Research Lancet Oncol Cancer Semin Diagn Pathol Radiology Radiology Cancer metastatic potential. A report of 3 cases and a review of the literature. Cancer Clin Orthop Neoplasms in Long Bones. J Bone Joint Surg Am Clin Orthop Expert Rev Mol Diagn

16 Chapter planning. Skeletal Radiol Rontgen Blatt

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