骨肿瘤外科分期定稿课件.pptx

1、Absence or presence of a sclerotic rimCT in evaluating the lungs for metastasesGroup 1 lesions are radiographically benign and do not require further investigation or treatment.X线表现：病变侵袭破坏明显，骨膜反应，软组织肿块影像引导下穿刺活检如Fluoroscopy with C-arm guidance，CT-guided biopsy胸部X线平片和CT检查应作为常规以发现肺转移灶M0：无局部和远处转移期（A B）：

2、低度恶性佛罗里达大学，Enneking，1977同位素扫描：反应带超出原发间室CT in evaluation of local diseaseAssessing peripheral vascular branches and tumor neovascularity.期（A B）：高度恶性病灶被成熟的纤维组织或皮质骨包围，极少反应性间质浸润、炎症反应和新生血管形成Absence or presence of a sclerotic rimCT和MRI：病灶不均质，早期就可能超出间室扩散X线平片：周围反应骨呈松质骨样，骨内膜呈扇贝样，可有Codmans三角X线平片：侵袭性强，与周边正常骨界面

3、呈破碎状，骨皮质破坏明显，有骨膜反应和Codmans三角间室内病变穿破解剖学间室：May produce false-positive results when small lung nodules are detected.X线表现：肿瘤界清，囊内生长呈膨胀性，罕见穿破囊壁者Follow-up CT scans are useful in monitoring the nodules.影像引导下穿刺活检如Fluoroscopy with C-arm guidance，CT-guided biopsy影像引导下穿刺活检如Fluoroscopy with C-arm guidance，CT-gu

4、ided biopsy病灶被成熟的纤维组织或皮质骨包围，极少反应性间质浸润、炎症反应和新生血管形成间室内病变穿破解剖学间室：Absence or presence of a sclerotic rimRadionuclide bone scans肘窝、腋窝、guo窝、腹股沟、骨盆内临床：有疼痛等症状，生长快，侵袭性强，迅速穿破屏障而播散标准化的要求：统一标准、有利于治疗资料和疗效的交流(interinstitutional and interdisciplinary communication)Evaluation of local disease in detail同位素扫描可显示远处或跳跃

5、性骨转移灶临床：肿瘤边界清，有完整包膜，极少远处转移反应带超出原发间室有肯定的细胞学恶性表现，包括间变、多形性（Broders1级，偶尔2级）。Provide additional information regarding neurovascular bundle involvement.原发病灶和反应带均局限在病灶的原发间室内在恶性肿瘤反映生物学侵袭程度Grade 1A,1B,and 1C lesions represent benign lesions with edge characteristics ranging from well defined to poorly define

6、d.1期：潜隐性跳跃转移、区域淋巴结或远处转移有反应骨包围但偏向于松质骨，内部皮质有嵴，覆盖的皮质有变形（LodwickB)Grade 2 lesions are low-grade malignant lesions with invasive features,particularly those with total penetration of the cortex.治疗的要求：手术时机、手术方法、切除范围的选择；CT和MRI：病灶不均质，早期就可能超出间室扩散X线平片：界清，边界有时不规则；病灶被成熟的纤维组织或皮质骨包围，极少反应性间质浸润、炎症反应和新生血管形成胸部X线平片和CT

7、检查应作为常规以发现肺转移灶反应带内有指状突起或卫星灶有肯定的细胞学恶性表现，包括间变、多形性（Broders1级，偶尔2级）。佛罗里达大学，Enneking，1977A 期 G2T1MO，间室内高度恶性放射学：平片示病灶界限清楚、形状和边界规则，有皮质骨样反应骨包围（LodwickA)；同位素扫描：反应带超出原发间室Absence or presence of a sclerotic rimEnnekingG-T-M外科分期系统原发病灶和反应带均局限在病灶的原发间室内Malignant lesions are typically more extensive and involve surr

8、ounding tissue to a greater extent than do benign lesions.Accurately detecting tumor involvement of neurovascular structures,muscle compartments,growth plates,and joints.分分期期分分级级部位部位转移转移临床进程临床进程治疗措施治疗措施1G0T0M0潜隐性，静止潜隐性，静止性，有自愈倾向性，有自愈倾向病损内手术病损内手术囊内手术囊内手术2 2G0T0M0进行性发展，膨进行性发展，膨胀性生长胀性生长边缘手术或边缘手术或加辅助治疗加

9、辅助治疗3 3G0T12M01具有侵袭性具有侵袭性广泛手术或广泛手术或加辅助治疗加辅助治疗佛罗里达大学，Enneking，1977A 期 G2T1MO，间室内高度恶性Absence or presence of a sclerotic rim影像引导下穿刺活检如Fluoroscopy with C-arm guidance，CT-guided biopsyFollow-up CT scans are useful in monitoring the nodules.Malignant lesions are typically more extensive and involve surrou

10、nding tissue to a greater extent than do benign lesions.Penetration of cortex by lesion3期 G0T12M01，良性侵袭性在恶性肿瘤反映生物学侵袭程度复杂，对手术治疗无指导价值胸部X线平片和CT检查应作为常规以发现肺转移灶X线平片：侵袭性强，与周边正常骨界面呈破碎状，骨皮质破坏明显，有骨膜反应和Codmans三角肘窝、腋窝、guo窝、腹股沟、骨盆内Provide additional information regarding neurovascular bundle involvement.标准化的要求：统

11、一标准、有利于治疗资料和疗效的交流(interinstitutional and interdisciplinary communication)A 期 G2T1MO，间室内高度恶性临床：有疼痛等症状，生长快，侵袭性强，迅速穿破屏障而播散标准化的要求：统一标准、有利于治疗资料和疗效的交流(interinstitutional and interdisciplinary communication)肿瘤与解剖学间隙的关系T临床：症状明显，肿瘤生长快，有跳跃性生长和软组织肿块，常早期就发生局部和远处转移组织学：基质成熟，分化好，细胞基质比例低，无恶性细胞学表现，如：细胞核深染、核分裂相、间变、多行

12、性；Complements radiography佛罗里达大学，Enneking，1977反应带内有指状突起或卫星灶A 期 G2T1MO，间室内高度恶性2期：活动性(active)-G0 T0 M0CT is also helpful in determining the internal contents of some lesions.在恶性肿瘤反映生物学侵袭程度临床：有疼痛等症状，生长快，侵袭性强，迅速穿破屏障而播散临床表现、组织学表现与A 期相似CT in evaluating the lungs for metastases白血病、淋巴瘤、骨髓瘤、尤文肉瘤、未分化小圆细胞肉瘤同位素扫

13、描可显示远处或跳跃性骨转移灶同位素扫描可显示远处或跳跃性骨转移灶Follow-up CT scans are useful in monitoring the nodules.X线平片：周围反应骨呈松质骨样，骨内膜呈扇贝样，可有Codmans三角Pattern of destruction(geographic or not geographic,appearance of marginal interface zone)Grade 3 lesions are high-grade malignant lesions with invasive,permeative,and destructi

14、ve features临床：症状明显，肿瘤生长快，有跳跃性生长和软组织肿块，常早期就发生局部和远处转移良性骨肿瘤的GTM分期与治疗措施的选择Penetration of cortex by lesion佛罗里达大学，Enneking，1977放射学分级Lodwicks分级白血病、淋巴瘤、骨髓瘤、尤文肉瘤、未分化小圆细胞肉瘤有反应骨包围但偏向于松质骨，内部皮质有嵴，覆盖的皮质有变形（LodwickB)间室内病变穿破解剖学间室：2期：活动性(active)-G0 T0 M0CT in evaluating the lungs for metastasesAbsence or presence an

15、d extent(if present)of the expanded cortical shellEvaluation of local disease in detail骨旁间隙内，未进入骨皮质，未穿破骨膜侵犯肌、筋膜同位素扫描可显示远处或跳跃性骨转移灶Absence or presence of a sclerotic rimAbsence or presence of a sclerotic rimX线表现：肿瘤界清，囊内生长呈膨胀性，罕见穿破囊壁者Pattern of destruction(geographic or not geographic,appearance of marginal interface zone)同位素扫描可显示远处或跳跃性骨转移灶病灶被成熟的纤维组织或皮质骨包围，极少反应性间质浸润、炎症反应和新生血管形成复杂，对手术治疗无指导价值Provide additional information regarding neurovascular bundle involvement.