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AIM: The aim of the study was to assess the incidence of tumor recurrence, iatrogenic peroneal nerve injury, and wound healing problems in a small cohort of patients with proximal fibular tumors who had undergone surgery, and to determine the relative risk of pre-operative biopsies on these outcome variables. METHODS: The study entailed a retrospective single-center analysis of patients with a histologically confirmed tumor in the proximal fibula who had undergone surgery at our institute between 2004 and 2019 (n = 66). The accuracy of diagnosis based on pre-operative biopsy (n = 10) was compared to the histological diagnosis based on resection specimens. The association between pre-operative biopsy and patient demographics and medical history as well as tumor recurrence, iatrogenic peroneal nerve injury, and impaired wound healing was analyzed statistically. The data were presented against a backdrop of bone cancer incidence and 5-year survival rates in China. RESULTS: Recurrence, iatrogenic peroneal nerve, and wound healing issues were identified in 5 (7.6%), 8 (12.1%), and 6 patients (11.0%), respectively. A biopsy was acquired from ten of 66 patients. The pre-operative biopsy diagnostic accuracy rate was 100%. Males had an 11.2-fold higher risk of undergoing pre-operative biopsy than females (95% CI, 1.3-94.1; P = 0.013). Pre-operative biopsies were 11.2 times more likely to be obtained from patients with malignant and benign aggressive tumors in the proximal fibula compared to benign tumors (95% CI, 1.1-63.1; P = 0.013). Patients who had undergone biopsy were 12.4 times more likely to receive Type I or Type II en bloc resection (95% CI, 1.5-104.3; P = 0.006) and had a 7.6-fold greater chance to have impaired wound healing (95% CI, 1.3-45.1; P = 0.040), which was observed mainly in osteosarcoma patients. There were no significant associations of biopsy with tumor recurrence (P = 0.162) and iatrogenic peroneal nerve injury (P = 0.095). CONCLUSIONS: Biopsy of proximal fibular lesions does not increase the risk for tumor recurrence and iatrogenic peroneal nerve injury but may be associated with post-surgical wound healing problems. This is particularly relevant for male patients and malignant and aggressive benign lesions, where biopsies are considerably more likely to be acquired to guide diagnosis and clinical management. Due to the relatively low incidence of this cancer type and the scarcity of pre-operative biopsies, larger cohort studies are warranted to validate the results. RELEVANCE FOR PATIENTS: Patients who present with proximal fibular tumors are often young. Depending on the diagnosis of the bone cancer subtype, the surgical intervention may entail highly invasive and risky procedures. Taken together, it is imperative to ensure accurate diagnosis of the bone cancer subtype to prevent unnecessary procedures. Diagnostic accuracy can be increased by acquiring a histological specimen of the malignant bone tissue. However, it is currently not completely established whether bone biopsies in the proximal fibula can be safely performed and whether such biopsies lead to seeding metastases. Because of the rarity of these tumors and procedures, studies are needed even when these entail a small sample size.
RESUMO
Ossification timeline is a critical issue in studies regarding sesamoid bones at metatarsophalangeal (MTP) joints, but actual knowledge is still incomplete. The present study determines the cutoff age of sesamoids ossification at MTP joints. We conducted a retrospective review of radiographs of the feet from 5553 males and 3225 females between November 2005 and September 2012 to identify presence of sesamoids at 5 MTP joints and 3 variations of hallucal sesamoids. Age-specific prevalence of each presence and variations was calculated and clustered to produce latent age groups corresponding to the sesamoid ossification process in males and females, respectively. Males older than 7 years of age were divided into 5 age groups (8-11, 12-15, 16-29, 30-76, and 77-92 years), while females were classified into 4 age groups (8-11, 12-26, 27-76, and 77-92 years). According to the characteristics of sesamoid prevalence in each age group, the pre-ossification stage was defined at age 1-7 years in both genders and the ossifying stage was defined at age 8-29 years in males and 8-26 years in females. We also defined ossified stage as age 30-92 years in male and 27-92 years in females. The ossifying and ossified stages include 2 or 3 substages in both genders. A clustering analysis provided novel cutoff age points as ossification timelines for the sesamoid bones at MTP joints in males and females, which may have an impact on future sesamoid and skeletal development research.