Surgical Staging System for Musculoskeletal Tumors (Enneking and MSTS)



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.

A system for the surgical staging of musculoskeletal sarcoma.

New Developments in the staging and imaging of soft tissue sarcomas.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, June 20, 2012 2:39 pm