Current management of Tenosynovial Giant Cell Tumours of the knee in the United Kingdom

Background

Tenosynovial Giant Cell Tumours (TGCTs) are a group of rare, benign, mesenchymal tumours involving synovium, bursae or tendon sheaths. There are two subtypes of TGCT (nodular (nTGCT) and diffuse (dTGCT)) and the current guidelines on the management of both is limited.

Methods

A questionnaire was distributed to members of the British Orthopaedic Oncology Society to investigate members’ management of primary and recurrent TGCT. Respondents were questioned on their chosen radiological investigations, use of biopsy, surgical and oncological management and follow up. Descriptive analysis of the qualitative data was performed through data coding.

Results

Eighteen responses were received from orthopaedic consultants subspecialising in sarcoma surgery. One was excluded due to practice outside of the United Kingdom (UK). Magnetic Resonance Imaging (MRI) was unanimously the primary investigation of choice. Biopsy rates varied depending on extent of disease, imaging appearances and MDT input.

Most surgeons manage primary and recurrent nodular and diffuse TGCT with an open excision. When surgery is performed by a knee or soft-tissue knee surgeon, excisions were more likely to be performed arthroscopically. A staged resection was most commonly performed for dTGCT.

Indications for additional therapies in dTGCT varied between units. Follow up regimens also varied, although unsurprisingly diffuse and recurrent disease were reviewed with increased frequency for a longer duration.

Discussion

TGCT is a rare, complex disease that encompasses a range of phenotypes. Despite a recent global consensus meeting, our data shows that TGCT is still investigated, managed, and followed up with great variability across the UK.