Angiography in the management of musculoskeletal tumors.

The contribution to pretreatment evaluation and surgical planning of 200 angiograms of bone and soft tissue lesions, mostly tumors, was evaluated. Their accuracy was studied by careful post-operative examination of gross surgical specimens and histologic sections. The angiograms were helpful in delineating the anatomic extent of lesions and, therefore, in planning the appropriate resection or amputation. This was particularly true in lesions treatable by radical local resection, such as most malignant tumors of soft tissues, giant cell tumors of bone, parosteal osteosarcomas, chondrosarcomas and occasional small central osteosarcomas. The angiograms were of some help in confirming or detecting residual or recurrent tumor and prior resection. This was not true immediately after inadequate local resections because residual tumor was likely to be quite small and reactive vascularity secondary to operation was confusing. Angiography was not accurate or helpful in distinguishing benign from malignant lesions when the clinical presentation and roentgenographic findings were confusing. The surgeon relied on biopsy rather than angiography. Aso, although we saw lymph node blushes on several angiograms, we could not reliably interpret whether or not this represented tumor metastasis. The vascularity of pathologic fractures was also confusing. Pelvic angiograms were difficult to interpret because of the complex anatomy. We made most of our serious mistakes in delineating tumor extent in pelvic lesions. Angiography is valuable in planning operative treatment of tumors if radical local resection is considered or if physical examination and roentgenographic findings do not indicate the appropriate level of amputation.