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MRI Evaluation of Ewing's tumors. Radiological anatomical correlation.
Abstract ID : 1338
Submitted by : camille thevenin-lemoine the 2016-02-15 23:56:04
Category : Margins in Sarcoma
Typology : Communication orale / Oral communication
Status : Validated
Authorisation to disclose : Yes/Oui
------------------------------------Introduction
The goal of surgery in Ewing's tumour is to remove the tumour by passing through healthy tissue, while preserving
maximum function. Therefore surgical planning is important. Several studies have shown the benefits of MRI to
determine the regional extension of the tumor. Current guidelines recommend surgical planning is based upon prechemotherapy MRI. However, there is a controversy whether pre or post chemo MRI enables the best surgical planning.
The goal was to determine which investigation provides the more accurate planning of tumor limits.
Materials and methods
This was a single center retrospective study. 50 Ewing tumors were treated between 2005 and 2015 in our institution. 24
cases involved long bones. 2 cases were excluded because MRI was not interpretable. 22 Ewing tumours of limbs were
eventually included: 7 femurs, 5 tibias, 5 fibulas, 4 humerus and 1 ulna. The average age was 17 years. MRI analysis
was performed on three sequences (T1, T1 gadolinium, T2 Fat sat or Stir). MRI before and after chemotherapy were
analyzed by 2 radiologists. The distance between the limit of the tumor and the ends of the bone on MRI was compared
with the histology of the resection specimen. Statistical analysis was performed with the software MedCalc.
Results
The inter and intra observer reproducibility were excellent (correlation coefficients between 0.97 and 0.99). Tumor
margins were significantly different between the MRI pre and post chemotherapy for all MRI sequences studied (p
<0.005). Correlation between MRI pre chemotherapy and histology was 0.96 (T1), 0.91 (STIR), 0.94 (T1 gadolidium).
Correlation between MRI post chemotherapy and histology was excellent 0.99 for the 3 sequences. For both MRI pre
and post chemotherapy, the better precision was achieved with T1 sequence. There was no benefit to gadolinium
injection. Mean differences between MRI T1 and histology was 19mm (CI 6mm) before chemotherapy and 6mm (CI
3mm) after chemotherapy. Using a margin of 15mm added to the limit of the tumor on MRI T1 post-chemotherapy
always lead to safe histologic margin.
Discussion and conclusion
Post chemotherapy MRI provided a more accurate assessment of the limits of Ewing's tumor. Surgical planning can
therefore be based upon post chemotherapy MRI. Surgical cuts can be only 15mm away from the limits as seen on MRI.
This is of major concern in children especially for metaphyseal tumors locations where accurate planning helps to
preserve the joint or the growth plate.
------------------------------------Keywords : Ewing, margin, MRI
Authors :
References : , , ,
Authors
Camille Thevenin-Lemoine 1, Louise Destombes 2, Anne Brouchet 3, Julie Vial 2, Jérome Sales de Gauzy 1,
1. service de chirurgie orthopédique pédiatrique, hôpital des enfants, toulouse, FRANCE
2. service d'imagerie pédiatrique, hôpital des enfants, toulouse, FRANCE
3. service d'anatomie et cytologie pathologiques, Oncopole, toulouse, FRANCE
Authors (raw format)
Thevenin-Lemoine Camille - email : camille.theveninlemoine@gmail.com Institution : hôpital des enfants Department :
service de chirurgie orthopédique pédiatrique City : toulouse Country : FRANCE Speaker : Yes
Destombes Louise - email : destombeslouise@gmail.com Institution : hôpital des enfants Department : service
d'imagerie pédiatrique City : toulouse Country : FRANCE Speaker : No
Brouchet Anne - email : brouchet.anne@chu-toulouse.fr Institution : Oncopole Department : service d'anatomie et
cytologie pathologiques City : toulouse Country : FRANCE Speaker : No
Vial Julie - email : vial.j@chu-toulouse.fr Institution : hôpital des enfants Department : service d'imagerie pédiatrique City
: toulouse Country : FRANCE Speaker : No
Sales de Gauzy Jérome - email : salesdegauzy.j@chu-toulouse.fr Institution : hôpital des enfants Department : service
de chirurgie orthopédique pédiatrique City : toulouse Country : FRANCE Speaker : No
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