Popliteal lymph nodes in patients with osteosarcoma: are they metastatic?

PURPOSE: To evaluate the prevalence, imaging appearance, and significance of popliteal lymph nodes (PLN) on magnetic resonance imaging (MRI) in patients with distal femoral or proximal tibial osteosarcoma (OS). METHOD AND MATERIALS: This study included consecutive patients with OS presenting from May 2016 to March 2018. Inclusion criteria were patients with distal femoral or proximal tibial OS with MRI and pathology at our institution. On MRI, two radiologists recorded primary tumor features (size, location, signal, extra-compartmental extension), and PLN characteristics (mean size, presence/absence of fatty hilum, mineralization, PET/bone scintigraphy avidity, contrast enhancement, and diffusion restriction). Tumor histology, stage, and clinical follow-up were recorded. Descriptive statistics were provided. RESULTS: Sixteen patients with OS (age 20 ± 10 (range10-40) years, 10/16 male) were included. Although 81% (13/16) of the patients had PLNs at presentation (size range 0.3-3.6 cm), fewer patients had extra-compartmental spread: intra-articular extension 50% (8/16), skip lesions 19% (3/16), lung metastases 31% (5/16), and osseous metastases 12% (2/16). Four (25% (4/16)) patients had PLN ≥ 1 cm; two were histologically proven reactive. One was presumed metastatic due to rapid development, mineralization, and FDG-avidity on PET/CT. The other ≥ 1 cm PLNs along with all twelve (75% (12/16)) that were < 1 cm in mean diameter were presumed non-metastatic with documented stability for at least 12 months of follow-up. CONCLUSION: PLNs are frequently visible on MRI in patients with OS but are rarely (prevalence = 6%) metastatic. Features on MRI which may suggest metastatic PLNs include large size > 1 cm and loss of a fatty hilum.

Evaluation of Musculoskeletal Radiology Fellowship Websites.

OBJECTIVE: Maintaining a complete musculoskeletal (MSK) radiology fellowship website is important for recruiting residents, particularly given implementation of the new MSK Match. The purpose of this study was to evaluate the comprehensiveness of MSK fellowship program websites during the first MSK Fellowship Match. MATERIALS AND METHODS: A list of MSK fellowships was obtained from the Society for Skeletal Radiology website. Each program's website was searched for the presence of 23 criteria previously identified as important for radiology residents applying to fellowships (Table 1); including information about the application process, program benefits, clinical and research training, and current fellows and faculty. We used t-tests and ANOVA to compare mean number of criteria present on websites between ACGME nonaccredited and accredited programs. RESULTS: Of 89 MSK fellowship programs (15 accredited vs 74 nonaccredited), 81 (91%) had a dedicated MSK fellowship website. Only 6 (7%) assessed at least two-thirds of criteria. The most frequently included information included contact information (100%, 89/89), program description (97%, 86/89), application requirements (92%, 82/88), and length of fellowship (91%, 81/89). The least common information included elective offerings (11%, 10/89), moonlighting opportunities (9%, 8/89), social life (9%, 9/89), and a listing of fellow/faculty publications (9%, 8/89). Nonaccredited programs reported significantly more items than accredited programs (12.3 vs 10.2, P = 0.022). CONCLUSIONS: MSK fellowship websites are inadequately comprehensive, with less than half of assessed criteria present, on average. Inclusion of key factors known to be important to radiology residents can serve as opportunities for MSK fellowship websites to better recruit residents.