Most chest wall bone tumors are malignant, 85%-90% occur in the ribs, 10%-15% in the sternum, and the ratio of male to female is 2:1. They can occur at any age, and the older the age, the higher the possibility of malignant chest wall bone tumors. Common benign chest wall tumors include: fibrous heteroplasmosis, chondrosarcoma, osteochondroma and sclerofibroma, etc.; common malignant chest wall bone tumors include: chondrosarcoma, myeloma, osteogenic sarcoma and Ewing sarcoma, etc. Symptoms and signs Slowly enlarging chest wall mass, 20%-25% are asymptomatic. It eventually causes chest pain, and symptoms of chest pain are more common in malignant bone tumors. Diagnostic tests Diagnosis: based on bone tumor biopsy. 1.Open biopsy The purpose is to excise biopsy for lesions with higher benign possibility, preferably with consultation of pathologists and radiologists, excisional biopsy is very suitable for malignant disease. Operation methods: longitudinal incision; sharp separation straight to the tumor, to go through the muscle tissue, do not go between the muscles; uninvolved anatomical gaps should not be revealed; avoid all large vascular nerves to avoid contamination; whole excision of reactive tissue, pseudoperitoneum, peritoneum and whole tumor, fixed with formalin or sent to freezing; bone trauma should be reduced as much as possible to avoid infection; strict hemostasis of the trauma; effective wound drainage; if biopsy If resection is continued after biopsy, the instruments should be changed. Needle aspiration biopsy is still an open biopsy, and the biopsy path should be within the resectable range. Fine needle biopsy: ①relies on cytological analysis by experienced pathologists; ②accuracy rate is 65%-95% (depending on the amount of specimen collected); ③immunohistochemical analysis cannot be done. Core needle biopsy: ① is a poking card structure with an outer casing that wraps around the core and grabs the tissue specimen; ② more samples can be obtained than fine needle aspiration and immunohistochemical analysis can be done; ③ the accuracy rate is 75%-95%. The disadvantages of needle aspiration biopsy are: it may penetrate to the necrotic part of the tumor and thus cannot make a diagnosis, or the tissue taken may be the reactive tissue around the tumor and cannot represent the actual tumor, relatively speaking, frozen section does not have these disadvantages. 3.Frozen section If the specimen is sufficient and the tissue is diseased, the diagnosis can be clarified; if the lesion is inflammation, culture is needed; whether further examination is needed can be clarified; rapid diagnosis can be made to decide further treatment (surgery). Differential diagnosis Imaging can distinguish chest wall tumors from lung tumors, and MRI can be used to distinguish soft tissue tumors from vascular lesions. Treatment options If a bone tumor of the chest wall is considered, every effort should be made to resect it, while avoiding incisional biopsy. The affected ribs should be removed in their entirety without regard to the chest wall defect. If the tumor is large and cannot be resected, every effort should be made to biopsy to obtain a pathological diagnosis. Puncture biopsy is suitable for the diagnosis of metastatic lesions and myeloma, and sternal tumor should be performed by sternotomy. Principles of chest wall reconstruction: chest wall defect caused by resection of chest wall mass, such as chest wall defect with area less than 5 cm, especially those located in the posterior chest wall with thick muscle protection, does not require chest wall reconstruction. ＞For chest wall defects larger than 5 cm, chest wall reconstruction is required, especially in the anterior or lateral chest wall. This is because large chest wall softening not only severely weakens the ventilation function of the lung, but also affects the patient’s ability to expel sputum after surgery, which is one of the main causes of early death. The following methods are generally used for chest wall reconstruction: 1. Autologous tissue reconstruction method Smaller chest wall defects can be repaired and fixed by using local muscle layer, cortex and subcutaneous tissue. The early postoperative abnormal respiratory movements will generally disappear gradually as the tissue heals and hardens. Lower defects can often be repaired and reinforced with partial or complete sutures using the diaphragm. If necessary, the branches of the phrenic nerve may be twisted to paralyze and distend the localized diaphragm, which is then sutured to the periphery of the defect. In cases with pleural adhesions or thickening, the lung can sometimes be repaired by suturing it to the periphery of the defect. The use of free broad fascia to repair the defect has been replaced by synthetic materials due to lack of stiffness. Transfer of the latissimus dorsi or pectoralis major muscle to repair the defect, or other methods to assist, are also preferred. In female cases, the ipsilateral or contralateral breast can sometimes be transferred to repair the defect, and the wound itself can be repaired with a skin graft. Partial or total sternal defects can be repaired by suturing the two sides of the pectoralis major muscles together in the midline. It can also be repaired by using large omentum graft with vascular tip. 2.Synthetic reconstruction method For larger chest wall defects, if only autologous tissues are used, satisfactory chest wall repair is often not achieved due to inconvenience or insufficient materials. This unsatisfactory chest reconstruction often leads to an important cause of postoperative lung function deficiency and respiratory complications. The application of synthetic products has greatly improved the results of chest wall reconstruction. Alloys (such as tantalum sheets, tantalum mesh, and stainless steel products) and other fibrous glass cloths, which were once recommended for application, are being eliminated because clinical practice has proven to have more serious drawbacks. In recent years, the literature mostly recommends Marlex and Prolene as repairing chest foreign bodies with less reaction and sometimes even surviving in infected tissues. In addition, manufactured Plexiglas materials are also a better repair material. Prognosis and prevention Prognosis: Chest wall bone tumor surgery has low mortality rate, low impact on lung function, long-term survival rate of 50% to 70%, chondrosarcoma has the best prognosis, and the more extensive the resection, the better the prognosis. Postoperative radiotherapy and chemotherapy can improve survival.