RESUMO
PURPOSE: The interobserver-variability of radiological diagnosis of benign bone tumors (BBT) and tumor-like lesions (TLL) was examined in order to identify difficult-to-diagnose entities, to examine the frequency of advanced diagnostics and to describe the number of interdisciplinary tumor center diagnoses (IDT) in comparison with diagnoses upon referral (ED) and radiologists´ diagnoses (RD). MATERIALS AND METHODS: We retrospectively reviewed 413 patients with 272 BBT and 141 TLL, classified either histologically or through interdisciplinary consultation. Discrepancies between groups were analyzed and rates of additional imaging and biopsy to establish diagnosis were assessed. RESULTS: In BBT the number of identical radiological diagnoses was 56 (ED) and 81â% (RD) compared to the IDT, while in the latter additional imaging were obtained in 30â% cases. In 21â% (12â% to establish diagnosis) BBT were biopsied, the ED matching the histology 40â%, the RD 60â% and the IDT 76â% of the time. For TLL diagnosed through radiology, ED and RD matched IDT 31â% and 61â% of the time, with additional imaging being obtained in 21â% of cases (IDT). In 36â% (27â% to establish diagnosis) biopsy was performed, with histological diagnosis matching the IDT, RD and ED in 51, 27 and 20â%. Diagnostic challenges were apparent in enchondromas, non-ossifying fibromas (NOF), solitary (SBC) and aneurysmal bone cysts (ABC). Ganglia can be misinterpreted as a tumor. CONCLUSIONS: Establishing a definitive diagnosis for BBT and TLL can be challenging with the latter posing greater difficulties. An interdisciplinary approach involving radiologists, orthopedics and pathologists was found to improve diagnostic accuracy. KEY POINTS: â¢âBenign bone tumors (BBT) and tumor-like lesions (TLL) present a diagnostic challenge, while enchondroma, NOF, SBC and ABC were difficult to diagnose, and ganglia can be misinterpreted as a tumorâ¢âAdditional imaging studies were required for diagnosis in 29â% and 21â% of cases for BBT and TLL, respectively, biopsies in 12â% of cases for BBT and 27â% for TLLâ¢âSound diagnoses can be made through interdisciplinary case discussion, while reducing the risk of overtreatment Citation Format: â¢âScheitza P, Uhl M, Hauschild O etâal. Interobserver Variability in the Differential Diagnosis of Benign Bone Tumors and Tumor-like Lesions. Fortschr Röntgenstr 2016; 188: 479â-â487.