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Diagnosis and management of sacral bone tumours
A D Porter1, A H Simpson, A M Davis
1University Musculoskeletal Oncology Unit, Mount Sinai Hosptial, University of Toronto, Ont.
Objective:
To evaluate the efficacy of current treatment in patients with sacral bone tumours.
Design:
Retrospective case series.
Setting:
A quaternary care unit within a teaching hospital.
Patients:
Twenty-nine patients with sacral tumours referred to the unit between 1983 and 1991. Follow-up was a minimum of 18 months.
Interventions:
Diagnostic biopsy in all patients. Plain radiography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and bone scanning. Sacral resection in patients with malignant or aggressive primary bone tumours.
Main Outcome Measures:
The accuracy of biopsy and local and systemic recurrence of the disease.
Results:
Symptoms were present for a mean of 12 months to the time of presentation. Low-back pain was present in 28 of 29 patients. Radicular pain and sacral nerve dysfunction were found more often in patients with malignant tumours. Only three patients had altered bowel habits. On rectal examination a mass was palpable in 61% of patients. The sacral abnormality was demonstrated by plain radiography in 6 of 9 cases, by ultrasonography in 2 of 7 cases, by bone scanning in all of 17 cases, by CT in 24 of 25 cases and by MRI in 17 of 18 cases. Fine-needle aspiration biopsy provided the correct diagnosis in only one of four patients. Transrectal biopsy resulted in tethering of the rectum to the tumour in two patients. Core needle biopsy gave an accurate diagnosis in eight of nine patients. Open biopsy was repeated to obtain adequate tissue in 3 of 19 patients.(ABSTRACT TRUNCATED AT 250 WORDS)