The significance of surveillance imaging in children with Ewing sarcoma and osteosarcoma.

Primary bone tumors in children and adolescents, while rare, pose significant challenges in diagnosis and management. Children treated for Ewing sarcoma and osteosarcoma are offered a 5-year follow-up program after end of treatment, including radiological surveillance of primary location of tumor and the lungs. There is no consensus regarding how often and how the children should be followed with radiological imaging. This retrospective descriptive study of 69 patients (34 with Ewing sarcoma and 35 with osteosarcoma) investigated the consequences of abnormal findings in 1279 follow-up images. Nine relapses were detected, 4 in the Ewing group (3 local and 1 pulmonary) and 5 in the osteosarcoma group (1 local and 4 pulmonary). Of these, only two patients exhibited symptomatic relapses, with the remainder identified through imaging. The positive predictive value for relapse detection was 0.44 in the Ewing group, and 0.5 in the osteosarcoma group. In the Ewing sarcoma patient image follow-up program, the probability of anomaly detection was 12% (95% CI, 10-15). For osteosarcoma patients, the likelihood was 6% (95% CI, 4-8). Our data indicates that abnormal findings on follow-up images rarely represents relapse of tumor. As the surveillance protocol differs between the patient groups, wherein Ewing sarcoma patients primarily are monitored through MRI while osteosarcoma patients are predominantly tracked via X-rays, there is an increased occurrence of incidental findings in the first group. However, it is imperative to interpret imaging data in conjunction with clinical information, avoiding isolated reliance on imaging results when making treatment decisions.

[Diagnostics and treatment of lipomas].

In this case report, a woman of 55 years suddenly developed foot pain and swelling 13 years after treatment for breast cancer. X-ray was found to be normal, and the symptoms were in three months interpreted as ligamentous sprains. Due to persistent pain and functional impairment together with a renewed X-ray suspicious for malignancy, an MRI scan was performed and signs of malignancy were confirmed. A biopsy from talus showed metastasis from a breast carcinoma, and the patient was treated with an amputation.

Computed tomography-guided radiofrequency ablation is a safe and effective treatment of osteoid osteoma located outside the spine.

INTRODUCTION: The aim of this study was to evaluate the long-term clinical outcome after computed tomography (CT)-guided radiofrequency ablation (RFA) in patients diagnosed with osteoid osteoma (OO) located in the upper and lower extremities. METHODS: The study population included 52 patients with a typical clinical history and radiologically confirmed OO who received CT-guided RFA treatment from 1998 to February 2014 at Aarhus University Hospital, Denmark. The clinical outcome was evaluated based on patient-reported outcome measures and medical record review. RESULTS: The response rate was 52/60 (87%). Pain relief after the first RFA treatment was found in 46/52 (88%) of the patients and after re-RFA in 51/52 (98%) of the patients. One patient underwent open resection after RFA. No major complications occurred, and four patients reported minor complications in terms of small skin burn, minor skin infection and hypoaesthesia at the entry point. In all, 50 of 52 (96%) patients reported to be "very satisfied" with the RFA treatment. CONCLUSION: CT-guided RFA is a safe and effective treatment with high patient satisfaction and it provides robust pain relief and improves the patients' quality of life. RFA should be the treatment of choice for most OO. FUNDING: not relevant. TRIAL REGISTRATION: The Danish Data Protection Agency approved the project with record number 2007-58-0010.