Benign:
1
Latent
G 0
T 0
M 0
2
Active
G 0
T 0
M 0
3
Aggressive
G 0
T 1-2
M 0-1
Malignant:
Stage determined by three different sub-categories
-Grade: Histology with aid of radiographic findings and clinical correlation
G 1: Low grade,
uniform cell type without atypia, few mitoses
G 2: High grade, atypical nuclei, mitoses pronounced
-Site:
T 1: Intracompartmental (Confined within limits of periosteum)
T 2: Extracompartmental (Breach in an adjacent joint cartilage, bone cortex (or periosteum)
fascia lata, quadriceps, and joint capsule)
-Metastasis:
M 0: No identifiable skip lesions or distant metastases.
M 1: Any skip lesions, regional lymph nodes, or distant metastases.
Enneking's Staging System of Malignant Bone Tumors, CORR 1980
Ia
Low grade, intracompartmental
G 1
T 1
M 0
Ib
Low grade, extracompartmental
G 1
T 2
M 0
IIa
High grade, intracompartmental
G 2
T 1
M 0
IIb
High grade, extracompartmental
G 2
T 2
M 0
IIIa
Low or High grade, intracompart.
G 1-2
T 1
M 1
w/ metastases.
IIIb
Low or High grade, extracompart.
G 1-2
T 2
M 1
w/ metastases.
- Discussion:
-Benign tumor staging uses Arabic numbers (1,2,3)
-Malignant tumors identified with Roman numerals and a letter (Ia, Ib, IIa, IIb, IIIa, IIIb)
-Treatment of any potentially malignant bone tumor always begins with:
-
staging: Chest CT scan to evaluate for pulmonary metastasis, bone scan or skeletal survey for distant metastases or skip lesions
-
biopsy
-
radiographic features:
Grading of bone tumors by analysis of nuclear DNA content using flow cytometry.
Principles of staging of soft-tissue sarcomas.
Staging of soft-tissue sarcomas. Prognostic analysis of clinical and pathological features.
Scintigraphy with gallium-67 citrate in staging of soft-tissue sarcomas of the extremity.
Current concepts review: The surgical staging of musculoskeletal staging of musculoskeletal sarcoma.
WF Enneking.
JBJS Vol 62-A. 1980. p 1027-1030.
A system for the surgical staging of musculoskeletal sarcoma.
WF Enneking et al.
CORR. Vol 153. 1980. p 106-120.
New Developments in the staging and imaging of soft tissue sarcomas.
EY Cheng and R. Thompson.
JBJS. Vol 81-A. No 6. June 1999. p 882.
