Suspected Bone Tumors Research Articles

Bone tumors: state-of-the-art imaging.

Imaging plays a central role in the management of patients with bone tumors. A number of imaging modalities are available, with different techniques having unique applications that render their use advantageous for various clinical purposes. Coupled with detailed clinical assessment, radiological imaging can assist clinicians in reaching a proper diagnosis, determining appropriate management, evaluating response to treatment, and monitoring for tumor recurrence. Although radiography is still the initial imaging test of choice for a patient presenting with a suspected bone tumor, technological innovations in the last decades have advanced the role of other imaging modalities for assessing bone tumors, including advances in computed tomography, magnetic resonance imaging, scintigraphy, and hybrid imaging techniques that combine two existing modalities, providing clinicians with diverse tools for bone tumor imaging applications. Determining the most suitable modality to use for a particular application requires familiarity with the modality in question, its advancements, and its limitations. This review highlights the various imaging techniques currently available and emphasizes the latest developments in imaging, offering a framework that can help guide the imaging of patients with bone tumors.

Bone Tumor Imaging: An Update on Modalities and Radiological Findings

Radiological imaging forms an integral part in the diagnostic and management algorithm of patients with bone tumors. Although plain radiography tends to be the first line of imaging in a patient with suspected bone tumor, advances in technology, computer software, physics and techniques have expanded the modalities available to us in the form of computed tomography (CT), magnetic resonance imaging, and various scintigraphy techniques. These imaging modalities in combination with a clinician led multi-disciplinary team help in the exact diagnosis, appropriate management, and monitoring of patients for recurrence. In this narrative review, we highlight the current applications of conventional imaging, the emerging role of hybrid imaging, and explore the future directions of radiological imaging in the management of patients with bone tumors.

ROLE OF MRI IN CHARACTERIZATION OF BONE TUMORS ASSUMING HISTOPATHOLOGY AS GOLD STANDARD

Introduction- In comparison to other neoplasms, bone tumor is relatively not so common and constitutes only 0.5% of the total world cancer incidence. Evaluation of bone neoplasms consists of a multimodality approach and whereas cross sectional imaging has extraordinarily improved the ability to characterize tumors. Aim And Objective- This study aims at evaluating MRI imaging pattern of bone tumors and their correlation with histopathology. Materials And Method: 80 patients with suspected bone tumors referred to Department of Radiology after fullling the inclusion criteria were included in the study. Contrast enhanced MRI orbit was performed and ndings were corelated with histopathology. Results: Amongst 80 patients, 48 were males(60%) and 32 were female(40%).The patient age ranged from 1 month to 55 year. The bone tumors consist of 50 malignant and 30 benign masses amongst which osteosarcoma and enchondroma were the most common respectively. Conclusion: The present study concludes that MRI is extremely useful modality to characterize bone tumors.

Neoplastic Elbow Diseases and Mimickers.

Tumors around the elbow are infrequent, and delayed diagnosis is a common theme because of the low incidence and lack of familiarity. However, just like any other site, the radiologic work-up of musculoskeletal tumors around the elbow remains the same, with plain films the first investigation in a patient with a suspected bone tumor and ultrasound the first modality to evaluate a soft tissue lump. The management of both bone and soft tissue tumors around the elbow is unique because of a large number of important structures in an anatomically confined space and little normal tissue to spare without severely compromising the joint's function. Many benign nonneoplastic entities can mimic bone and soft tissue tumors on imaging. It is important to keep the characteristic imaging appearance in mind while formulating a differential diagnosis to avoid an unnecessary additional work-up. This article reviews the most common benign and malignant bone and soft tissue tumors around the elbow, mimickers, imaging features, and current therapeutic concepts.

Role of magnetic resonance imaging in diagnosis of pediatric bone tumors

ObjectivesTo evaluate the diagnostic effect of MRI in pediatric patients with suspected bone tumors and other bone pathologies.BackgroundBony lesions in pediatric age group is a frequent cause of pain and swelling. MRI is used to evaluate such patients, and information delivered by MRI is used to diagnose these lesions, whether benign or malignant. In addition, information delivered by MRI is used to guide biopsy procedure.Patients and methodsThis was a prospective study that included 50 patients. All were referred to the MRI unit in the diagnostic Radiology Department at Menoufia University Hospital from Menoufia University Hospital clinics and private clinics from June 2015 to November 2018.ResultsOur study revealed that MRI plays a sensitive diagnostic role in most cases not solved by plain radiography, for example, characterization of bony lesions like fatty content, cysts with and without fluid–fluid levels, and cartilaginous matrix, and also in aggressive bone lesions, MRI is used for locoregional staging and noninvasive evaluation of response to neoadjuvant treatment.ConclusionMRI is a sensitive and specific tool in primary detection and staging of pediatric bone tumors and tumor-like conditions. MRI helps guide biopsy from the soft tissue components and increases the chance of obtaining a definitive diagnostic result.

Role of diffusion-weighted MRI in differentiating benign from malignant bone tumors.

Objective:To evaluate the role of diffusion-weighted MRI in differentiating benign from malignant primary bone tumors. To know the sensitivity and specificity of diffusion weighted MRI and calculating apparent diffusion coefficient (ADC) cutoff in differentiating benign from malignant primary bone tumors.Methods and materials :This is a prospective observational study of 50 patients, who were clinically or radiologically suspected with primary bone tumor and referred to the Department of Radiodiagnosis, for radiography or for MRI. These patients underwent routine MRI sequences including diffusion-weighted MRI with b-values of 0, 500 and 1000, followed by pathological examination supplemented by immunohistochemistry (wherever necessary). Hematological malignancies, recently biopsied cases and recurrent cases were excluded from the study.Results:Out of 50 patients with suspected bone tumors, 15 were benign (and tumor like lesions) and 35 were malignant primary bone tumors. The most common age group involved for both benign and malignant primary bone tumors was 11–20 years (23 cases—46%). In our study, total number of affected males were 27 (54%) and total number of affected females were 23 (46%) with M:F ratio of 1.17:1. In this study 72% lesions had appendicular bone involvement and 28% had axial bone involvement. 94.3% of malignant lesions showed restriction on diffusion-weighted imaging (DWI) and in 80 % of benign lesions restriction was absent on DWI which was statistically significant. Mean ADC levels in malignant lesions was 1.092 ± 0.497 and in benign lesions was 1.62 ± 0.596 which was statistically significant. Chondrosarcoma had highest ADC and Ewing’s sarcoma had lowest ADC values in malignant lesions. Chondroblastoma had highest ADC and Osteomyelitis had lowest ADC values in benign lesions. ADC value of 1.31 had highest sensitivity and specificity to differentiate between benign and malignant lesions.Conclusion:DWI is helpful in differentiating malignant from benign bone tumors and tumor like lesions with diffusion restriction favoring malignancy. Inspite of some overlap, ADC values of benign and malignant bone tumors are different and measurement of ADC values improves the accuracy of the diagnosis of bone tumors and tumor like lesions. Calculation of ADC may also be used as baseline reference to assess response to treatment in future or for follow up.Advances in knowledge:DWI imaging (and ADC values) has been extensively used in neuroimaging. Extension of this application to musculoskeletal–oncologic imaging is not so well studied. Apart from differentiating benign from malignant lesions which is the main focus of this study, assessment of response to treatment by ADC values may be possible in near future.

3D computed tomography angiography as a novel post-processing approach in diagnosis of pediatric malignant bone tumors.

This study aimed to investigate the application of 3D computed tomography (CT) angiography with a novel post-processing technique in diagnosis of malignant bone tumors in children. Twenty-seven pediatric patients (15 males and 12 females; average age: 10±3.4 years old, with a range from 2 months to 14 years old) with suspected bone tumors were evaluated histopathologically using 3D CT angiography and a multislice scanner. CT angiography image data were analyzed with a novel post-processing technique that included separating, fusing opacifying false-coloring, and volume rendering. Among 27 cases, 20 (74%) osteosarcoma, 6 (22%) Ewing's sarcoma, and 1 (4%) non-Hodgkin lymohoma were diagnosed by histological examination of surgical specimens. The tumor features, including size, location, invasion into the adjacent tissue as well as distant metastases, were clearly visualized with the regular volume rendering method and rotational and stereoscopical videos. The post-processing technique provided the reconstructed structure images without any overlap or shelter independently and collectively. Special colors represented different tissue structures, aiding in identification of various anatomical structures and pre-surgical planning. Compared to traditional 3-D CT methods, 3-D CT angiography with rotational and stereoscopical videos provides more detailed information of bone tumor lesions. It offers a superior and effective imaging technique in pediatric patients with malignant bone tumors.

Perspectives of primary health care physicians on diagnosing and referring patients with apparent osteolytic lesions on plain X-ray films: a cross-sectional study.

Background and objectivesThe identification and diagnosis of musculoskeletal symptoms are major challenges for primary care physicians. A lack of clinical suspicion, limited exposure, and referral of patients to nonspecialized centers can delay the management of cases, which in turn can increase morbidity and mortality.Subjects and methodsFour different sets of X-ray films were shown to 91 primary health care physicians. The first two were normal, whereas the third and fourth showed bone lesions. Participants were asked to indicate the presence of an abnormality, the diagnosis, and the approach to referral if required.ResultsThere was a variation in the results for the first two sets of normal X-ray films. Most participants (73.6%) were able to diagnose the first case correctly. However, 73.6% of participants were unable to diagnose the second case correctly. A high percentage of participants (90.1%) were able to detect abnormalities in Cases 3 and 4, with nearly all participants indicating that they would refer patients to centers other than bone oncology centers in the western region of Saudi Arabia if they suspected bone tumors. Only 25.8% of participants were aware of these bone oncology centers.ConclusionPhysicians in many primary health care centers need practice in reading normal X-ray films to avoid unnecessary referral of patients to specialized medical centers. We recommend the development of a new system for referring patients suspected to have bone tumors to avoid a delay in the management of cases and to decrease morbidity and mortality.

Diagnostic value of 99mTc-MDP SPECT/spiral CT combined with three-phase bone scintigraphy in assessing suspected bone tumors in patients with no malignant history.

Three-phase bone scintigraphy using technetium-99m-methylene diphosphonate is used to diagnose skeletal lesions, whereas single-photon emission computed tomography/computed tomography (SPECT/CT) improves the diagnostic accuracy of bone disease. We investigated the usefulness of SPECT/CT combined with three-phase bone scintigraphy over three-phase bone scintigraphy alone in assessing suspected bone tumors in patients with no malignant history. Forty-eight patients (30 men and 18 women; mean age, 43.3 ± 20.1 years; age range, 11-82 years) with suspected bone tumors who underwent technetium-99m-methylene diphosphonate three-phase bone scintigraphy and SPECT/CT between July 2008 and August 2013 were retrospectively reviewed. The lesion from each patient was resected or biopsied for pathological confirmation of the diagnosis within 3 weeks of the bone scan. All images were interpreted by two experienced nuclear medicine physicians who had not been involved in the selection of data for the present study. The reviewers were aware of the patient's sex, age, and the lesion's site but were unaware of the results of other imaging modalities, such as radiography, MRI, and laboratory tests. In cases of discrepancy regarding the interpretations, a consensus was reached after mutual discussion. The diagnostic ability of three-phase bone scintigraphy and SPECT/CT combined with three-phase bone scintigraphy was compared with pathological results using the χ(2)-(test, with P-values less than 0.05 indicating significant differences. Agreement between three-phase bone scintigraphy alone or SPECT/CT combined with three-phase bone scintigraphy with pathological results was evaluated using κ scores. Pathological results from the 48 lesions of all patients revealed 32 malignant bone tumors and 16 benign lesions. On using three-phase bone scintigraphy and SPECT/CT combined with three-phase bone scintigraphy for the differential diagnosis of bone lesions, we found sensitivities to be 96.9 and 100%, specificities to be 31.2 and 81.3%, positive predictive values to be 73.8 and 91.4%, and negative predictive values to be 83.3 and 100%, respectively. The diagnostic accuracies of three-phase bone scintigraphy alone and SPECT/CT combined with three-phase bone scintigraphy were 75.0 and 93.8%, respectively (χ(2) = 5.057; P = 0.025). κ Scores for the agreement of three-phase bone scintigraphy and SPECT/CT combined with three-phase bone scintigraphy with pathological results were 0.333 (P = 0.005) and 0.850 (P < 0.0001), respectively. Compared with three-phase bone scintigraphy, the diagnostic accuracy of SPECT/CT combined with three-phase bone scintigraphy was higher. SPECT/CT combined with three-phase bone scintigraphy is beneficial over three-phase bone scintigraphy for the differential diagnosis of suspected bone tumors in patients with no malignant history.

Utility of Fine Needle Aspiration Cytology in Diagnosing Bone Tumors

Aim: Fine needle aspiration cytology (FNAC) for cytodiagnosis of various lesions is routinely used in many centers. In bone, however, FNAC has not been widely applied because of concerns about its diagnostic accuracy. The present study aims to determine the value of FNAC in the diagnosis of bone tumors. Methods: It was a progressive observational study conducted over a period of one year, undertaken on suspected bone tumor cases in Acharya Vinoba Bhave Rural Hospital, Wardha, India. The material obtained was smeared on glass slides and stained with Giemsa stain. Results: A total of 36 cases were studied, of which diagnostic material was adequately obtained in 32 cases (88.88%). The sensitivity (92.85%) and specificity (94.44%) of FNAC were high, with an accuracy of 93.75%, which is similar to findings in other studies. Conclusion: FNAC plays a vital role in diagnosing bone tumors. It is a rapid, easy, cheap, and minimum invasive outpatient department procedure. However histopathology is still important in diagnosing bone tumors that are unclear or undiagnosed on FNAC since histopathology gives a complete architectural pattern of tissue.

Fine needle aspiration cytology versus core needle biopsy in the diagnosis of primary bone tumors: a retrospective study

Background Fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) are two outpatient procedures used in the differential diagnosis of a suspected bone tumor. Although open biopsy is a recommended procedure, its invasive nature mandates the search of a minimally invasive procedure for the diagnosis of a bone tumor prior to surgical resection or radio/chemotherapy. Therefore, the aim of this study was to compare the FNAC and CNB regarding their diagnostic accuracy in the diagnosis of primary bone tumor.

Radiographic and Scintigraphic Evaluation of Bone Tumors and Diseases.

A primary bone tumor is a neoplasia that originates within the skeletal tissue. Primary musculoskeletal tumors are rare and account for <1% of all cancers. Approximately 2500 new cases of primary bone malignancy are diagnosed each year in the United States1,2. The vast majority of bone tumors are benign and asymptomatic and therefore are likely to remain undetected or are diagnosed incidentally1,2. In turn, the true incidence of benign bone tumors is difficult to estimate1,2. In one study, the prevalence of metastatic bone disease was estimated to be approximately 280,000 cases in the U.S. in 20083. Primary bone tumors can be benign or malignant and can vary in terms of aggressiveness and activity. While some benign and indolent lesions may be asymptomatic, aggressive malignant lesions may present with pain, pathologic fractures, and metastasis. Appropriate characterization and diagnosis of bone tumors is necessary for determining therapeutic strategies1,2. Conventional radiography is the first diagnostic tool that is used for the assessment of suspected bone tumors and is considered to be the most important initial imaging modality4-9. Conventional radiography can …

Tru-cut biopsy as the initial method of tissue diagnosis in bone tumors with soft tissue extension

Background:Tru-cut biopsy in suspected bone tumors can be performed even in less specialized centers. Tru-cut biopsy has been proved as safe with more than 90% accuracy. However, its usefulness was not widely studied in general hospitals where Tru-cut biopsy is performed by orthopedic surgeons. This study was conducted to find out the accuracy and adequacy of Tru-cut biopsy performed by an orthopedic surgeon not trained in musculoskeletal oncology, in a general hospital.Materials and Methods:A study was conducted through a prospectively collected database using a uniform protocol. All patients who had a malignant appearing bone lesion with a palpable soft tissue mass were included in the current study. Fifty such consecutive cases underwent Tru-Cut biopsy by orthopedic residents or registrars who were aware of the principles of Tru-cut biopsy and the recommendations of Musculoskeletal Tumor Society. When an open biopsy or a resection of the tumor was subsequently performed, the histological diagnosis was compared for accuracy with the diagnosis of needle biopsy. We evaluated adequacy of sample obtained and accuracy of diagnosis in terms of sensitivity, specificity, positive predictive value, and negative predictive value.Results:Seventy seven cases were initially enrolled. Out of which 18 were excluded and 59 patients were biopsied. Out of which 50 were analysed. Only 4 out of 50 biopsied specimens were inadequate resulting in an adequacy rate of 92%. Among 46 cases, which were analyzed for diagnostic accuracy, 84.78% had true-positive result, 8.69% had true negative, and 6.52% had false-negative report. The sensitivity and specificity of Tru-cut biopsy in our series was 92.85% and 100%, respectively, with positive predictive value of 100% and negative predictive value of 57.14%.Conclusions:Tru-cut biopsy can be recommended as an initial method of tissue diagnosis in musculoskeletal tumors with soft tissue extension.

The added value of (99)Tcm-MDP SPECT/CT combined with three-phase bone scintigraphy for differential diagnosis in patients with suspected bone tumor

Objective To investigate the added value of SPECT/CT combined with three-phase bone scintigraphy for differential diagnosis in patients with suspected bone tumor compared with 99Tcm-MDP three-phase bone scintigraphy.Methods Forty-five patients with mean age (44.1 ±21.2) years who were suspected to have bone tumors,underwent 99Tcm-MDP three-phase bone scintigraphy and SPECT/CT between July 2008 and September 2011.They were retrospectively reviewed.All patients had pathological diagnosis based on surgical resection or lesion biopsy.The three-phase bone scintigraphy images were analyzed,and combined SPECT/CT images were then analyzed by two experienced nuclear medicine physicians.The third nuclear medicine physician would be consulted if there was disagreement between these two investigators.Each lesion was diagnosed as either malignant or benign.Compared with the pathology diagnosis,the diagnostic ability of three-phase bone scintigraphy images and SPECT/CT combined with threephase bone scintigraphy were evaluated.The diagnostic accuracy of three-phase bone scintigraphy images and SPECT/CT combined with three-phase bone scintigraphy were calculated,and x2 test was used to compare the difference between them.Results Among these 45 lesions,29 were malignant and 16 benign.Using three-phase bone scintigraphy and SPECT/CT combined with three-phase bone scintigraphy for the differential diagnosis of bone lesions,the sensitivity,specificity,positive predictive value and negative predictive value were 96.6％ (28/29) vs 100％ (29/29),37.5％ (6/16) vs 81.2％ (13/16),73.7％ (28/38) vs 90.6％ (29/32),and 6/7 vs 100％ (13/13),respectively.The diagnostic accuracy of the three-phase bone scintigraphy was 75.6％ (34/45),and up to 93.3％ (42/45) for the combined examination (x2 =4.145,P ＜0.05).Conclusions Compared with three-phase bone scintigraphy alone,the diagnostic accuracy of SPECT/CT combined with three-phase bone scintigraphy is significantly improved.The combination might provide added value over three-phase bone scintigraphy for differential diagnosis in patients with suspected bone tumor. Key words: Bone neoplasms; Radionuclide imaging; Tomography,emission-computed,single-photon; Tomography,X-ray computed; MDP

Diagnosing SAPHO Syndrome in Suspected Metastatic Bone Tumors

Abstract: A previously healthy 44-year-old woman who had been followed at different health care facilities for symptoms which had begun 3 years earlier was referred to our service for clinical evaluation. Her problems during the initial examination were pain in the sternoclavicular and sacroiliac joints as well as plantar pustulitis. Based on previous x-ray hyperostosis findings, metastatic bone tumors to the spine and first costocondral junctions bilaterally were suspected. A biopsy of the sternoclavicular lesion showed a nonspecific inflammation pattern. On the first physical examination we found a nontender swelling of the sternoclavicular junctions, necrosis of the plantar epidermis and pain at the sacroiliac joints. The patient was referred for bone scintigraphy and positron emission tomography-computed tomography (PET-CT) scan. The whole body bone scintigraphy using Tc-99m MDP showed increased accumulation of the radiotracer in the anterior chest wall and in the right sacroiliac joint. Metastatic bone tumor was not suggested, although exclusion of bone metastases was difficult. The PET-CT with F-18 FDG showed areas with low metabolic activity in the anterior chest wall (SUV Max: 1.96) and in the right sacroiliac joint (SUV Max: 2.18) making the diagnosis of malignancy and acute infection unlikely. The clinical symptoms, the typical skin lesions involving the soles of the feet and low hypermetabolic lesions on PET-CT made the final diagnosis of SAPHO syndrome.

Differential diagnosis between osteomyelitis and bone tumors

Hematogenous osteomyelitis is often difficult to distinguish from a bone tumor because clinical findings are noncontributory and radiological features can mimic a bone tumor. Recently, the penumbra sign, a higher signal intensity feature of the thin layer of granulation tissue which lines the abscess cavity on T1-weighted magnetic resonance (MR) images, has been reported to be helpful for discriminating subacute osteomyelitis. To determine helpful findings for distinguishing osteomyelitis from bone tumors. The laboratory and imaging findings of a consecutive series of 244 patients referred to our institution with a suspected bone tumor were reviewed. There were 15 cases of osteomyelitis, 160 bone tumors, and 69 tumor-like lesions. In osteomyelitis, the C-reactive protein (CRP) level increased in nine patients and the penumbra sign was seen in 11 patients. In bone tumors and tumor-like lesions, a high CRP level was observed in 21 patients and the penumbra sign was seen in two patients. The sensitivity of the penumbra sign for osteomyelitis was 73.3%, with a specificity of 99.1%. The penumbra sign and a high CRP level support the diagnosis of osteomyelitis and may help to exclude the presence of a tumor.

Bone Tumors Specific in Children

Primary bone tumors in pediatric age group are uncommon, and even when they do occur, they are usually benign. The primary malignant tumors that occur predominantly in children are two bone tumors, namely, osteosarcoma and Ewing's sarcoma. An adequate history and physical examination are the first and most important steps in evaluating a patient with a bone tumor. All suspected bone tumors should be evaluated initially with plain roentgenograms. Then the additional diagnostic studies, such as computed tomography(CT), magnetic resonance imaging(MRI) and technetium bone scan can be used, if necessary. Biopsy should be the last step in evaluation. Most of benign bone tumors usually do not require treatment other than a periodic follow-up evaluation. The optimal treatment of the malignant bone tumor often requires a combination of radiation therapy, chemotherapy, and wide surgical excision or amputation. Early detection of a malignant bone tumor not only may make the difference between life and death but also may allow successful salvage surgery rather than amputation of the limb.

Rentabilité de la ponction–biopsie percutanée dans le diagnostic des tumeurs osseuses vertébrales et périphériques

Objectives. – Percutaneous biopsy is widely used for the diagnosis of primary and secondary bone malignancies. The primary objective of this study was to evaluate the contribution of percutaneous biopsy to the definite diagnosis in patients with suspected bone tumor. The secondary objective was to assess the potential diagnostic benefits of a second percutaneous biopsy when the first failed to provide the diagnosis. Methods. – We retrospectively reviewed 108 percutaneous biopsies of bone lesions in 89 patients admitted to our rheumatology department from January 1994 to December 2001. There were 61 men and 28 women with a mean age of 59 years. The biopsies was done under computed tomography guidance in 68 patients and fluoroscopy in 21 patients. Results. – The diagnostic yield of percutaneous biopsies was 68.5% overall and was significantly higher in patients with metastatic bone disease (100%) than in patients with primary tumors (83%) or hematological malignancies (58%) ( P = 0.0004 and P < 0.0001, respectively). Yields were higher for peripheral lesions (85%) than for vertebral (65%) and pelvic (60%) lesions. Yields were 87% for lytic lesions, 66% for sclerotic lesions, and 50% for mixed lesions. When soft tissues were sampled, the yield was 100%, as compared to 86% for biopsies composed only of bone. Conclusion. – Percutaneous biopsy of suspected bone tumors is a safe and inexpensive procedure that consistently ensures the diagnosis of bone metastases. The diagnostic yield is lowest in patients with bone lesions caused by hematological malignancies. When two biopsies fail to provide the diagnosis, further biopsies are unlikely to be helpful.

Contribution of percutaneous biopsy to the definite diagnosis in patients with suspected bone tumor

Objectives. – Percutaneous biopsy is widely used for the diagnosis of primary and secondary bone malignancies. The primary objective of this study was to evaluate the contribution of percutaneous biopsy to the definite diagnosis in patients with suspected bone tumor. The secondary objective was to assess the potential diagnostic benefits of a second percutaneous biopsy when the first failed to provide the diagnosis. Methods. – We retrospectively reviewed 108 percutaneous biopsies of bone lesions in 89 patients admitted to our rheumatology department from January 1994 to December 2001. There were 61 men and 28 women with a mean age of 59 years. The biopsies were done under computed tomography guidance in 68 patients and fluoroscopy in 21 patients. Results. – The diagnostic yield of percutaneous biopsies was 68.5% overall and was significantly higher in patients with metastatic bone disease (100%) than in patients with primary tumors (83%) or hematological malignancies (58%) ( P = 0.0004 and P < 0.0001, respectively). Yields were higher for peripheral lesions (85%) than for vertebral (65%) and pelvic (60%) lesions. Yields were 87% for lytic lesions, 66% for sclerotic lesions, and 50% for mixed lesions. When soft tissues were sampled, the yield was 100%, as compared to 86% for biopsies composed only of bone. Conclusion. – Percutaneous biopsy of suspected bone tumors is a safe and inexpensive procedure that consistently ensures the diagnosis of bone metastases. The diagnostic yield is lowest in patients with bone lesions caused by hematological malignancies. When two biopsies fail to provide the diagnosis, further biopsies are unlikely to be helpful.

Primary Bone Tumors in Children

The combination of clinical information and the findings on conventional radiographs should lead the physician to a narrow differential diagnosis. Before biopsy, appropriate diagnostic and staging studies should be carried out. The biopsy reveals the pathologic diagnosis and a definitive treatment plan then can be instituted. An algorithm is provided for the evaluation and treatment of a child with a suspected bone tumor (Fig. 14).