Significance of image analysis in the diagnosis of bone tumors and tumor-like lesions

The distinction between different types of giant-cell containing lesions often represents a challenge for pathologists since wide ranges and overlappings of their morphological features are common. But despite of their similarities the treatment is very different and depends on an accurate morpological diagnostic. Our present study was undertaken to investigate the nuclear DNA content (NDC) of giant-cell containing lesions and its value for the diagnostic. Furthermore we studied the significance of NDC to predict the biological behavior of giant-cell tumors. 12 aneurysmal bone cysts 25 central osteosarcomas (biopsies) and 16 giant-cell tumors of the Hamburger Knochentumorregister were included in this study. In all cases fresh material was available. 20 imprintcytologies from each specimen of each case were prepared . 10 were used for Feulgen-staining to perform quantitative DNA-measurements. 10 were used for Pappenheim-staining for morphological examination. Conventionally prepared sections of each specimen of each patient radiological findings and clinical data served as control-system. The recently developed DNA measuring program CESAR based on image analysis (IBAS I Kontron Germany) was used for this study. The obtained DNA distributions were classified according to a new developed DNAgrading system for imprintcytologies (s. table 1). All investigated aneurysmal bone cysts were 0 I (euploid). 23 central osteosarcomas were G III (aneuploid). 2 central osteosarcomas (predominantly cartilage producing) were G II (only a small number of hypertetraploid cells). 9 giant-cell tumors were G II. 7 Giant