A Study of Agreement between Clinicoradiological and Histopathological Diagnosis of Bone Tumours and Tumour: Like Lesions with FNAC Study in Selected Cases

Shubha, G (2015) A Study of Agreement between Clinicoradiological and Histopathological Diagnosis of Bone Tumours and Tumour: Like Lesions with FNAC Study in Selected Cases. Masters thesis, Madurai Medical College, Madurai.


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BACKGROUND: Bone tumours and tumour-like lesions are rare. However, they cause significant morbidity and mortality. Histopathological examination of bone tumours is considered to be a challenging field in pathology and final diagnosis should be given only after review of clinical and radiological findings. FNAC (Fine Needle Aspiration Cytology) evaluation of bone tumours is a safe, simple and cost-effective procedure that is minimally disruptive to bone. In this era of neoadjuvant chemotherapy and limb salvage surgeries, FNAC is proving to be a valuable tool in preliminary diagnosis of bone tumours. This study aims at elaborating the various bone tumours and analysing the age and gender distribution of these tumours. The agreement between clinico-radiological and histopathological diagnosis of bone tumours has been studied. An attempt has been made to study the FNAC findings of bone tumours. Immunohistochemical markers have been used to confirm diagnosis in challenging bone tumours. METHODS: The study was carried out in the Department of Pathology, Madurai Medical College, Madurai, during the period from May 2012 to July 2014 on 90 specimens of bone tumours and tumour-like lesions received in the department after exclusion of specimens with leukaemic infiltration of marrow. After adequate fixation and decalcification, representative bits were taken, processed and stained with Haematoxlyin and Eosin. The cases were classified based on WHO classification, 2002. Cohen’s Kappa value was calculated to test the strength of agreement between clinico-radiological and histopathological diagnosis. FNAC was performed on 15 bone tumours and slides stained with H&E after fixation. The observations were compared with other studies and inferences drawn. The provisional histopathological diagnosis of two bone tumours was confirmed by immunohistochemical markers. RESULTS: Bone tumours and tumour-like lesions formed only 1.03% of all diagnosed neoplasms received in the department during the study period. Benign bone tumours formed 58.9% of the study material and 36.7% were malignant bone tumours. Among the malignant tumours, 66.7% were primary bone malignancies and 33.3% cases were metastatic deposits. Cartilage tumours formed the major category constituting 43.3%. Osteosarcoma was the most common primary bone malignancy (50%) while osteochondroma was the commonest benign tumour (66%). The incidence of tumours was maximum during second decade of life (45.6%). Osteosarcoma and osteoid osteoma showed predilection for males. Bone tumours were most commonly encountered around the knee joint (23.3%). Metastasis occurred most commonly in the femur (36.4%). 85 cases showed agreement between clinicoradiological and histopathological diagnosis. In 5 cases, the histopathological diagnosis was not in agreement with clinicoradiological diagnosis. Cohen’s Kappa value was 0.943 which showed excellent agreement between clinicoradiological and histopathological diagnosis. Out of the 12 adequate FNAC smears, categorisation was correctly done in 10 cases. However, in 2 cases of suspected osteosarcoma, a cytological diagnosis of sarcoma, not otherwise specified was given due to lack of osteiod. These two cases were later confirmed by histopathology to be osteosarcoma. IHC was used to confirm a provisional histopathological diagnosis of primary bone lymphoma using CD 45 immunostain. Also, a provisional histopathological diagnosis of metastatic deposits of follicular thyroid carcinoma to skull with occult primary was confirmed by TTF -1 and Thyroglobulin immunomarkers. CONCLUSION: There is very good agreement between clinico – radiological and histopathological diagnosis in bone tumours. However, many benign bone tumours and tumour - like lesions mimic malignant lesions radiologically. Hence, histopathological confirmation of radiological diagnosis should always be done before definitive treatment. A close co – ordination between the orthopaedician, radiologist and pathologist is the best approach to treat a patient with bone tumours. Cytology can serve as a good tool for rendering quick and cost effective diagnosis for further management. However, the results of FNAC should be cautiously interpreted and when in doubt, histopathological confirmation should be obtained before treatment. Immunohistochemistry has its own role in bone tumour diagnosis. It can be a valuable tool in categorising small round cell tumours and determining sites of occult primary in case of metastasis to bone.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Bone tumours ; tumour-like lesions ; osteosarcoma ; Fine Needle Aspiration Cytology (FNAC) ; Radiology ; Immunohistochemistry.
Subjects: MEDICAL > Pathology
Depositing User: Punitha K
Date Deposited: 19 May 2018 15:14
Last Modified: 22 May 2018 18:47
URI: http://repository-tnmgrmu.ac.in/id/eprint/7988

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