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Surgical Staging System for Musculoskeletal Tumors (Enneking and MSTS)

                 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.

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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.