Morphological classification for prediction of malignant transformation in multiple exostoses

Area of Science:

• Orthopedic oncology
• Radiology
• Pathology

Background:

• Multiple exostoses (ME) are benign bone tumors.
• Malignant transformation of ME into chondrosarcoma is a known complication.
• Predictive markers for malignant transformation are crucial for patient management.

Purpose of the Study:

• To evaluate the utility of morphological tumor classification in predicting malignant transformation in multiple exostoses.
• To determine if specific tumor shapes are associated with a higher risk of malignant change.

Main Methods:

• Retrospective analysis of imaging data from 116 patients with 190 tumors.
• Pathological confirmation of all resected tumors (175 exostoses, 15 chondrosarcomas).
• Classification of tumors based on tip-to-base diameter ratio (R1) into cauliflower-like (R1 ≥ 1.0) and non-cauliflower-like (R1 < 1.0) types.

Main Results:

• Cauliflower-like tumors were significantly more frequent in malignant chondrosarcomas compared to benign exostoses (p < 0.05).
• The sensitivity and specificity of cauliflower-like morphology in predicting chondrosarcoma were 86.7% and 84.6%, respectively.
• A high negative predictive value (98.7%) suggests cauliflower-like morphology is a strong indicator of malignancy.

Conclusions:

• Cauliflower-like morphology is associated with a higher incidence of malignant transformation in multiple exostoses.
• Morphological classification can aid in identifying high-risk lesions.
• Preventive resection of cauliflower-like tumors may be a strategy to prevent malignant transformation.