背景:在10%-16%的骨巨细胞瘤(GCTB)中发现了流体水平(FFL),并且FFL的存在增加了对GCTB伴继发性动脉瘤性骨囊肿(ABC)的怀疑,这可能导致术中出血增加,模糊手术领域,与局部复发的风险有关。这项研究的第一个目的是确定继发性ABC是否与四肢GCTB患者刮治后局部复发的高风险相关。这项研究的第二个目的是调查敏感性,特异性,正预测值,以及在磁共振成像(MRI)上检测到的FFLs的存在对诊断与GCTB相关的继发性ABC的阴性预测值。
方法:这项研究纳入了1980年至2021年在作者机构接受刮宫的四肢GCTB患者。
结果:在280例患者中有36例(12.9%)发现了继发性ABC,在280例患者中有66例(23.6%)发生了局部复发。多变量分析显示继发性ABC与局部复发之间无显著相关性(风险比[HR]:1.87(95%置信区间[CI]:1.00-3.53];p=0.051)。术前MRI显示82例患者中有13例(15.9%)出现FFL。灵敏度,特异性,正预测值,术前MRI诊断继发性ABC的FFLs阴性预测值为36.8%,90.5%,53.8%,82.6%,分别。
结论:这项研究的结果表明,继发性ABC并不增加四肢GCTB患者刮宫后局部复发的风险。虽然罕见,FFLs存在于GCTB患者中,在术前MRI中检测到的FFLs中有一半具有继发性ABC。
BACKGROUND: Fluid-fluid levels (FFLs) is found in 10%-16% of giant cell tumor of bone (GCTB), and the presence of FFLs raises the suspicion of GCTB with secondary aneurysmal bone cyst (ABC), which can lead to increased intraoperative bleeding and, blurring the operative field, be associated with a risk of local recurrence. The first objective of this study is to determine whether secondary ABC is associated with a higher risk of local recurrence after curettage in patients with GCTB of the extremities. The second objective of this study is to investigate the sensitivity, specificity, positive predictive value, and negative predictive value of the presence of FFLs detected on magnetic resonance imaging (MRI) to diagnose secondary ABC associated with GCTB.
METHODS: Two hundred and eighty patients with GCTB of the extremities who underwent curettage at the authors\' institutions between 1980 and 2021 were included in this study.
RESULTS: Secondary ABC was found in 36 of 280 patients (12.9%) and local recurrence occurred in 66 of 280 patients (23.6%). Multivariate analysis showed no significant correlation between secondary ABC and local recurrence (hazard ratio [HR]: 1.87 (95% confidence interval [CI]: 1.00-3.53]; p = 0.051). Preoperative MRI revealed FFLs in 13 of 82 patients (15.9%). Sensitivity, specificity, positive predictive value, and negative predictive value of FFLs detected on preoperative MRI to diagnose secondary ABC were 36.8%, 90.5%, 53.8%, and 82.6%, respectively.
CONCLUSIONS: The results of this study showed that secondary ABC does not increase the risk of local recurrence after curettage in patients with GCTB of the extremities. Although rare, FFLs were present in patients with GCTB and half of those with FFLs detected on preoperative MRI had secondary ABC.