Protocols for the Examination and Reporting of Bone and Soft Tissue Tumors (Letters to the Editor) (Letter to the Editor)
To the Editor.–I read with interest the recently published protocols for the examination and reporting of soft tissue tumors of intermediate malignant potential, malignant soft tissue tumors, and benign or locally aggressive and malignant bone tumors. (1) The article provides an extensive overview of the grade, stage, and margins for these tumors, as well as summary checklists that pathologists can use in daily practice. The protocols recommend using the tumor, node, metastasis (TNM) staging system of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC), the system currently used for tumors of almost every organ system. However, many, if not most, orthopedic oncologists apply the Musculoskeletal Tumor Society (MSTS)/Enneking staging system (2,3) when determining the appropriate surgical management of patients with bone and soft tissue sarcomas. The MSTS system is simple to implement because it merges a 2-tiered grading scheme with the local extent of the tumor and the presence or absence of metastatic disease to place a patient into 1 of 3 stages (Table 1). From a practical standpoint, the differences between the staging systems are relatively minor. For soft tissue tumors, the AJCC/UICC system divides the high-grade sarcomas into 2 separate stages (stages II and III) on the basis of a combination of size less than or greater than 5 cm and the depth of the tumor; the MSTS staging system regards all low-grade soft tissue sarcomas as stage I and all high-grade soft tissue sarcomas as stage II, regardless of size and depth. The same is true for bone tumors, for which the stages for both low-grade and high-grade tumors are divided according to tumor size greater than 8 cm.
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