Materiały źródłowe

• #1 Classification, imaging, biopsy and staging of osteosarcoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4052020/

  Osteosarcoma is the most common primary osseous malignancy excluding malignant neoplasms of marrow origin (myeloma, lymphoma and leukemia) and accounts for approximately 20% of bone cancers. […] The conventional plain radiograph is the best for probable diagnosis as it describes features like sun burst appearance, Codman’s triangle, new bone formation in soft tissues along with permeative pattern of destruction of the bone and other characteristics for specific subtypes of osteosarcomas. […] The biopsy confirms the diagnosis and reveals the grade of the tumor. […] The common staging systems for malignant bone tumors are: Enneking system for staging malignant musculoskeletal tumors and the American Joint Committee on Cancer (AJCC) System for staging bone sarcomas. […] The plain radiograph provides the best clue to the diagnosis and MRI the local extent. Thorax CT scan and Tc99 bone scan are used for the detection of lung and bony metastasis respectively. The biopsy confirms the diagnosis and reveals the grade of the lesion.

• #1 Osteosarcoma (Osteogenic Sarcoma): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15041-osteosarcoma

  Osteosarcoma is cancer that begins in your bones, usually in the arms or legs. Limited movement, bone pain, a lump and an unexplained broken bone are the most common symptoms. […] Osteosarcoma is a type of bone cancer that most commonly affects kids and teens. Osteosarcomas most commonly form on long bones near joints, like knees, hips or shoulders. […] A healthcare provider will begin with a thorough history and physical examination. Theyll ask about your symptoms and medical history. […] Your provider might also use some tests when making a diagnosis, including: Biopsy, Blood tests, CT scan, MRI, X-ray. […] After your provider diagnoses osteosarcoma, the next step is to find out if the cancer cells have spread. This is called staging. […] The most common treatments are chemotherapy (chemo) and surgery to remove osteosarcoma tumors and cancer medications to kill cancer cells throughout your body.

• #1 Osteosarcoma Diagnosis

  https://tamc.co.il/en/article/osteosarcoma-diagnosis/

  Osteosarcoma occurs in people aged 10 to 30 years. This disease occurs during the period of active bone growth. In the early stages, the tumor is very difficult to detect. Patients highlight the following symptoms: […] occurrence of limp; […] the appearance of pain at night; […] occurrence of swelling; […] fatigue, anxiety, sleep disturbance; […] weight loss and temperature. […] Over time, swelling in the joint increases and movement is disrupted. It is necessary to urgently consult a doctor if there is a suspicion of osteosarcoma. […] To make the correct diagnosis, qualified specialists use the following diagnostic methods: […] X-ray analysis. In the picture, the focus of bone damage will be visible. […] Biopsy. To clarify the diagnosis and correctness of therapy, it is necessary to take the material for study. […] Computed tomography. It will help to consider the tumor in more detail and its spread to other tissues. […] Magnetic resonance imaging. Allows you to determine the area of the lesion and the area of metastasis. […] Then, based on the obtained data, the specialist selects the optimal therapy scheme taking into account the general state of the patient and the features of the development of pathology.

• #1 Osteosarcoma – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/780

  Osteosarcoma is the most common non-haematological primary malignant neoplasm of bone in children and adolescents. […] Pain and swelling are the most common presenting symptoms. […] Although it can occur at any age, it usually affects patients in the second and third decade of life with a peak incidence between 13 and 16 years of age. It is more common in males than females. […] Chemotherapy combined with surgery is the standard of care. […] Prognosis of patients with localised disease has improved substantially following the introduction of chemotherapy, with 75% to 80% 5-year survival rates. […] The World Health Organization defines osteosarcoma as a primary osseous malignant neoplasm composed of mesenchymal cells producing osteoid and immature bone, even if only in small amounts.

• #1 Osteosarcoma – Diagnosis & Disease Information

  https://www.cancertherapyadvisor.com/ddi/osteosarcoma/

  Osteosarcoma is the most common type of bone cancer.1 It primarily affects children, adolescents, and young adults.1 Osteosarcoma most often forms in the long tubular bones of the arms and legs.2 Although many cases of osteosarcoma are detected early, this cancer is characterized by a high degree of malignancy, strong invasiveness, rapid progression, and a high mortality rate.2 To provide patients with optimal care, clinicians need to understand the risk factors, diagnosis, and treatment of osteosarcoma. […] Prompt diagnosis of osteosarcoma is necessary to avoid metastasis and poor outcomes. Clinicians need to recognize and accurately diagnose this disease while ruling out other potential etiologies.2,10,11 […] Patients with osteosarcoma often present with nonspecific symptoms.10 The most common early symptoms are pain and swelling around the affected bone, particularly during sleep or when bearing weight.11 This pain may worsen over time, even without signs of infection or injury.10 Upon palpation, clinicians may note a mass. The skin may also be erythematous and warm to the touch.10 Mobilizing the affected joint will reveal restrictions in motion. Up to 10% of patients with osteosarcoma will present with a fracture as the first manifestation of the disease.10

• #1

  https://tumorsurgery.org/tumor-education/bone-tumors/types-of-bone-tumors/telangiectatic-osteosarcoma.aspx

  Telangiectatic osteosarcoma is a variant of an intramedullary high grade osteosarcoma. […] Telangiectatic osteosarcoma is extremely lytic on X-rays. It demonstrates very little osteoid production. […] The cystic spaces filled with hemorrhagic material leads to the presence of fluid-fluid levels on MRIs (so called ABC-like changes or telangiectatic change). […] ABC- like changes can sometimes lead to a misdiagnosis on X-rays and the tumor may be misinterpreted as being a benign ABC. […] Alkaline phosphatase levels are usually normal. […] Pathologic fractures occur in 25% of patients because the lesion is extremely lytic. […] Osteoid usually not discernible on X-ray but scant and faint lace-like osteoid may be detectable on a CT scan. […] MRI and CT are also useful for demonstrating the local extent of the tumor and any soft tissue mass.

• #1 Bone Cancer: Diagnosis and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0815/p205.html

  The diagnosis of bone cancer can be challenging because of its low incidence and nonspecific symptoms at presentation. Timely diagnosis occurs when physicians consider bone cancer in the differential diagnosis and promptly obtain imaging. […] […] Certain genetic syndromes increase the risk of osteosarcoma. Patients with bilateral retinoblastoma, which arises from an alteration in the oncogene Rb, have a 40% chance of developing osteosarcoma by 40 years of age. Clinical conditions that result in bone turnover increase the risk of bone cancer. Examples include metal implants within the bone from orthopedic interventions and Paget disease. Patients with a history of radiation therapy have a higher risk of osteosarcoma in previously irradiated bone. […] […] Plain radiography is the preferred imaging modality for diagnosing malignant bone tumors. Patients commonly associate initial symptoms with minor trauma, and primary care physicians often order radiography of the affected limb with a clinical suspicion for fracture rather than bone malignancy. When radiographic findings raise suspicion for bone malignancy, laboratory studies should be obtained to evaluate other systems. […]

• #1 Tests for Osteosarcoma | Diagnosing Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/detection-diagnosis-staging/how-diagnosed.html

  Osteosarcomas are usually found because a person is having signs or symptoms, which prompt a visit to a doctor. If a bone tumor is suspected, exams and tests will be needed to find out for sure. […] If an osteosarcoma is found, other tests will then be done to learn more about it. […] If the doctor suspects a person could have osteosarcoma (or another type of bone tumor), more tests will be done. These might include imaging tests, biopsies, and/or lab tests. […] People who have or might have osteosarcoma will have one or more of these tests. […] Even if results of an x-ray strongly suggest a person has osteosarcoma, a biopsy will still be needed to confirm that it is cancer rather than some other problem, such as an infection. […] The results of imaging tests might strongly suggest that a person has osteosarcoma (or some other type of bone cancer), but a biopsy is the only way to be certain.

• #1 Osteosarcoma – Wikipedia

  https://en.wikipedia.org/wiki/Osteosarcoma

  An osteosarcoma (OS) or osteogenic sarcoma (OGS) is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin (and thus a sarcoma) and that exhibits osteoblastic differentiation and produces malignant osteoid. Osteosarcoma is the most common histological form of primary bone sarcoma. It is most prevalent in teenagers and young adults. […] X-rays is the initial imaging of choice to diagnose osteosarcoma. Some characteristics of osteosarcoma on X-rays are sunburst appearance and Codman triangle (elevation of bony cortex by the tumour that caused new bone formation). CT scan is helpful in defining the bony anatomy, the integrity of the bony cortex, detecting pathologic fracture, and assessing ossification (laying of new bone materials) and calcification of the cartilage. On the other hand, soft tissue and medullary cavity is better imaged by MRI scan.

• #1 Final Diagnosis — Case 10

  https://path.upmc.edu/cases/case10/discussion.html

  By the time of diagnosis, most osteosarcomas have broken through the cortex and periosteum and are bulky masses that often cause obvious swelling of the extremity. […] The neoplasms appear as gray-white, aggressive masses that often contain areas of hemorrhage and cystic softening. […] As the neoplasm penetrates the cortex, it lifts the periosteum and a characteristic Codman’s triangle is produced-the angle between the plane of the outer surface of the cortex and the elevated periosteum. […] The tumor may spread widely in the marrow cavity, but it rarely penetrates the epiphyseal plate to involve the joint space; this may, however, occur after epiphyseal closure. […] Histologically, these tumors vary in the richness of the osteoid or cartilaginous or vascular components, but common to all is a basically anaplastic mesenchymal parenchyma that in places is punctuated by the formation of osteoid matrix by tumor cells.

• #1 Osteosarcoma Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1256857-workup

  Most of the laboratory studies that are obtained relate to the use of chemotherapy. It is important to assess organ function before administering chemotherapy and to monitor function after chemotherapy. Important laboratory studies include the following: […] The only blood tests with prognostic significance are LDH and ALP. Patients with an elevated ALP at diagnosis are more likely to have pulmonary metastases. In patients without metastases, those with an elevated LDH are less likely to do well than are those with a normal LDH. […] Plain radiography in primary, posteroanterior (PA), and lateral chest views is helpful. No single feature on a radiograph is diagnostic. Osteosarcoma lesions can be purely osteolytic (~30% of cases), purely osteoblastic (~45% of cases), or a mixture of both.

• #1 Osteosarcoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteosarcoma/diagnosis-treatment/drc-20351053

  Osteosarcoma diagnosis may begin with a physical exam. Based on the findings of the exam, there might other tests and procedures. […] Imaging tests make pictures of the body. They can show the location and size of an osteosarcoma. Tests might include: X-ray, MRI, CT, Bone scan, Positron emission tomography scan, also called a PET scan. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. The tissue might be removed using a needle that is put through the skin and into the cancer. Sometimes surgery is needed to get the tissue sample. The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Your healthcare team uses this information to make a treatment plan. […] Determining the type of biopsy needed and how it should be done requires careful planning by the medical team. The biopsy needs to be done so that it won’t get in the way of future surgery to remove the cancer. Before having a biopsy, ask your healthcare professional to refer you to a team of experts who have experience treating osteosarcoma.

• #1 Multimodal Imaging of Osteosarcoma: From First Diagnosis to Radiomics

  https://www.mdpi.com/2072-6694/17/4/599

  Following the initial radiographic diagnosis, the assessment of osteosarcoma can benefit from a thorough evaluation using CT and MRI. These imaging modalities provide a more detailed assessment of the tumor’s composition, extent, and involvement of surrounding tissues, all of which are critical for formulating an effective treatment plan for osteosarcoma. […] MRI is the preferred imaging modality for assessing tumor bulk, local disease extent, and its relationship with surrounding structures due to its superior tissue differentiation. It provides a clear visualization of cartilage, muscles, fascia, and neurovascular bundles, and it represents the preferred modality to monitor tumor changes during treatments. […] Overall, the accurate assessment of tumor extent and composition is essential not only for surgical planning but also for predicting therapeutic response. Recent evidence suggests that baseline MRI findings may help in predicting chemo-resistant osteosarcoma, with tumor size emerging as the strongest predictor.

• #1 Classic Osteosarcoma Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/393927-overview

  The National Comprehensive Cancer Network (NCCN) recommends that the initial workup for osteosarcoma include imaging of the primary site by MRI with or without CT scanning and chest imaging, including chest CT and head-to-toe PET/CT scan and/or bone scan. More detailed imaging of abnormalities identified on primary imaging by CT or MRI is required when metastatic disease is suspected. […] MRI is the most important imaging technique for the accurate local staging of osteosarcoma; in addition, it assists in determining the most appropriate surgical management. For the purposes of staging, assessment of the relationship of a tumor to the anatomic compartment in which it originated and to other adjacent compartments is of vital importance. […] The assessment of the extent of extraosseous tumor involves a determination of which muscle compartments are involved and of the relationship of the tumor to neurovascular structures and adjacent joints.

• #1 Diagnosis for Osteosarcoma | American Oncology Institute

  https://www.americanoncology.com/cancer-we-treat/diagnosis/osteosarcoma

  X-rays: Once the patients are suspected of having bone mass, tumor, or osteosarcoma, they are advised to undergo a radiographic examination. The results of the radiographic examination may reveal bone destruction. The other characteristic features of the radiographic results in osteosarcoma are cloud-like lesions and osteoid matrix calcification due to the tumor. […] Magnetic resonance imaging: It is a preferred imaging modality in diagnosing osteosarcoma. The technique further characterizes the presence of lesions identified during radiographic examination. MRI also assists in detecting the spread of tumors inside and outside the bone. The radiologists generally involve one joint above and below the affected bone to avoid skipping the lesions. MRI also provides valuable information about the spread of the tumor to surrounding soft tissues, neurovascular bundles, and joint involvement.

• #1 Osteosarcoma Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1256857-workup

  A CT scan of the primary lesion and a CT scan of the chest (high resolution) should be obtained. CT of the primary lesion helps delineate the location and extent of the tumor and is critical for surgical planning. […] MRI of the primary lesion is the best method of assessing the extent of intramedullary disease, as well as associated soft-tissue masses and skip lesions. This imaging modality is perhaps the single most important study for accurate surgical staging of the lesion with use of the Enneking staging system. […] Two elements are important to the histologic examination of the tumor. The first, tumor type, can be assessed on the biopsy. The second, response to treatment, can be assessed on the definitive resection following chemotherapy. […] The purpose of staging tumors is to stratify risk groups. The conventional staging used for other solid tumors is not appropriate for skeletal tumors, because these tumors rarely involve lymph nodes or regional spread.

• #1 Classic Osteosarcoma Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/393927-overview

  Osteosarcoma is the most common primary malignant tumor of bone, excluding plasma cell myeloma. High-grade intramedullary osteosarcoma is the classic, or conventional, form accounting for approximately 80% of all lesions. Osteosarcoma has 2 peak ages: 18 and 60 years of age. Osteosarcoma may affect any bone but most frequently occurs in the metaphyseal areas of the distal femur and proximal tibia. Osteosarcoma spreads hematogenously, with metastasis to the lung being most common. It is treated by a combination of surgical excision and chemotherapy. […] For patients with classic osteosarcoma, radiography is almost always the initial imaging modality. Once the diagnosis is suspected, magnetic resonance imaging (MRI) is essential to determine the distribution of the tumor within the bone and the extent of any associated soft tissue mass. Computed tomography (CT) scanning is less sensitive than MRI in local evaluation of the tumor, but it is used in the staging of pulmonary metastases. Suspicion of osteosarcoma that is based on radiographic findings still requires a bone biopsy specimen for definitive diagnosis. CT imaging of the chest should also be performed to identify lung nodules.

• #1 Diagnosis for Osteosarcoma | American Oncology Institute

  https://www.americanoncology.com/cancer-we-treat/diagnosis/osteosarcoma

  Computed tomography scan: CT scan is not used once the tumor is detected through the radiographic examination and MRI scan. The CT may assist in disease staging and planning the surgery. However, in patients with lytic lesions, a CT scan may be used as the radiographic examination, and MRI may not be able to detect this type of lesion. Further, a CT scan is the preferred imaging modality for evaluating the chest for metastatic osteosarcoma. […] PET scan: PET scan detects the spread of osteosarcoma in various body parts. The technique specifically detects metabolically active lesions. Once the suspicious mass is detected during the preliminary imaging methods, the patients may undergo a PET scan to determine the extent of tumor lesions and to identify subtle lesions. The patients may also expect a PET scan to diagnose cancer recurrence.

• #1 Multimodal Imaging of Osteosarcoma: From First Diagnosis to Radiomics

  https://www.mdpi.com/2072-6694/17/4/599

  Osteosarcoma is a primary malignant bone tumor that produces an osteoid matrix. Imaging is crucial for detection, characterization, and treatment planning, though it can be challenging, especially in the early stages. Conventional radiography is typically the first modality used to detect suspicious findings, while the Bone-RADS system helps describe imaging results and stratify risk. CT provides detailed insight into bone architecture and the osteoid matrix, while MRI is essential for assessing tumor spread to adjacent soft tissues, the medullary canal, joints, and neurovascular structures. The review includes clinical case examples and explores the role of artificial intelligence in improving osteosarcoma diagnosis. […] Osteosarcoma is a primary malignant bone tumor characterized by the production of an osteoid matrix. Although histology remains the definitive diagnostic standard, imaging plays a crucial role in diagnosis, therapeutic planning, and follow-up. Conventional radiography serves as the initial checkpoint for detecting this pathology, which often presents diagnostic challenges due to vague and nonspecific symptoms, especially in its early stages. Today, the integration of different imaging techniques enables an increasingly personalized diagnosis and management, with each contributing unique and complementary information. Conventional radiography typically initiates the imaging assessment, and the Bone Reporting and Data System (Bone-RADS) of the Society of Skeletal Radiology (SSR) is a valuable tool for stratifying the risk of suspicious bone lesions. CT is the preferred modality for evaluating the bone matrix, while bone scans and PET/CT are effective for detecting distant metastases. MRI reveals the extent of the lesion in adjacent soft tissues, the medullary canal, and joints, as well as its relationship to neurovascular structures and the presence of skip lesions. Advanced techniques such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), and perfusion MRI help characterize the tumor environment and assess treatment response.

• #1 Diagnosis of bone cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/bone/diagnosis

  An MRI is used to confirm the diagnosis of a bone tumour found on an x-ray. It can also look to see if the cancer has spread into the surrounding tissues and other parts of the bone. […] A CT scan is used if an MRI cannot confirm that an area in the bone is a tumour. It may also be used to see how far a tumour has spread inside the bone, into the soft tissues around the tumour or into the lymph nodes. […] A biopsy is used to confirm the diagnosis of bone cancer and find out what type of cancerous tumour it is. […] A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to find out if bone cancer has spread to other bones. […] Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find abnormalities, but they are not used to diagnose bone cancer itself. […] A CBC is done to give your healthcare team information about your general health.

• #1 Diagnosis for Osteosarcoma | American Oncology Institute

  https://www.americanoncology.com/cancer-we-treat/diagnosis/osteosarcoma

  Bone scan: Bone scan is the method to detect bony metastasis. The technique involves using radionucleotide, which is injected into the vessels and accumulated in the abnormal areas of the bone. […] Biopsy: The biopsy is a procedure that involves obtaining samples of the affected bone and sending them to the laboratory to detect the presence of cancer cells. There are several types of biopsy for osteosarcoma. These are: […] Core needle biopsy: Core needle biopsy involves using a thin, hollow needle to remove the bone tissue as a cylinder. The procedure is performed under the action of local anesthesia. If the tumor is deep inside the bone, ultrasound (ultrasound-guided biopsy) or CT scan (CT-guided biopsy) may assist in the biopsy. […] Surgical biopsy: In cases where the tumor sample is not obtained through core needle biopsy, the patients may have to undergo surgery to obtain the sample. The procedure is done under anesthesia. The skin is cut, and the sample is removed by exposing the affected bone.

• #1 Osteosarcoma: Symptoms, Tests & Treatments

  https://www.healthline.com/health/osteosarcoma

  Osteosarcoma is a bone cancer that typically develops in the shinbone (tibia) near the knee, the thighbone (femur) near the knee, or the upper arm bone (humerus) near the shoulder. […] Your child’s doctor can use a variety of tools to diagnose osteosarcoma. They will first conduct a physical examination to look for swelling and redness. The doctor will also request information about your child’s medical history. This includes previous illnesses and past medical treatments. […] Your child’s doctor may do a simple blood test to check for tumor markers. These are chemical readings in the blood that indicate the presence of cancer. Other tests used to diagnose osteosarcoma include: CT scan: a 3-D X-ray used to examine bones and soft organs in the body, MRI: uses sound waves and powerful magnets to create images of internal organs, X-ray: produces images of dense tissue inside the body, including bone, PET scan: a full body scan often used to detect cancer, biopsy: removal of a tissue sample from the bone for testing, bone scan: a sensitive imaging test that shows bone abnormalities that may be missed by other imaging tools (bone scans can also tell doctors whether the cancer has spread to other bones).

• #1 Osteosarcoma: Symptoms, Causes, Treatment, & Prognosis

  https://www.webmd.com/cancer/what-is-osteosarcoma

  Radionuclide bone scan. A technetium-99m methylene diphosphonate bone scan can help detect the spread of osteosarcoma and bone cancer. It’s a less expensive but less specific alternative to PET scans. […] Follow-up MRI or CT (both with contrast). These scans are needed if nuclear imaging finds the cancer has metastasized, or spread far outside the bone. […] Fertility consultation. Treatment for bone cancer can affect fertility.

• #1 Osteosarcoma: Symptoms, Causes, Treatment, & Prognosis

  https://www.webmd.com/cancer/what-is-osteosarcoma

  CT scan, which stands for computed tomography. CT scans are used for biopsy planning and disease staging. […] Biopsy. Your doctor will take a small sample of bone or tissue from a painful or swollen area. They may use a needle or make a cut in your skin, called a surgical or open biopsy. A specialist looks at the sample under a microscope. This test may show cancer cells in your bone or cancer cells that have spread to muscles or other areas. […] If you are diagnosed with osteosarcoma, your doctor may order other tests to stage your cancer to determine whether it has spread and if it spreads slowly or quickly. This includes: […] Nuclear imaging: […] Positron emission tomography or PET scans. These scans are especially used to determine tumor extent and find subtle lesions. During your treatment, PET scans may be used to find cancer recurrence.

• #1 Testing for Bone Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/bone-cancer/detection-diagnosis-staging/how-diagnosed.html

  If the tumor is most likely a primary bone cancer, its very important that the biopsy is done by doctors experienced in treating bone tumors. […] The type of biopsy done is based on whether the tumor looks benign (not cancer) or malignant (cancer) and exactly what type of tumor it most likely is (based on imaging tests, the patients age, and where the tumor is). […] All samples removed by biopsy are sent to a pathologist (a doctor specializing in lab tests) to be looked at with a microscope. If cancer cells are seen, other types of lab tests might also be done to learn more about the exact type of cancer.

• #1 Bone cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bone-cancer/diagnosis-treatment/drc-20350221

  Bone cancer diagnosis often involves imaging tests to look at the affected bone. To be certain whether a growth in the bones is cancer, a piece of tissue might be removed and tested for cancer cells. […] Imaging tests make pictures of the body. They can show the location and size of a bone cancer. Tests might include: […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. For bone cancer, the sample of tissue might be collected by: […] Determining the type of biopsy you need and the details of how to do the biopsy requires careful planning by your medical team. […] If you’re found to have bone cancer, often the next step is to find out the extent of the cancer. This is called the cancer’s stage. Your healthcare team uses your cancer’s stage to help create your treatment plan.

• #1 Osteosarcoma Overview

  https://www.texasoncology.com/types-of-cancer/bone-cancer/osteosarcoma-overview

  It is imperative that patients with diagnosed or suspected osteosarcoma undergo an evaluation by an orthopedic oncologist who is familiar with surgical management of this disease. […] There are several methods for diagnosing osteosarcoma. At this time, controversy exists over which of these methods is optimal. […] An open incisional biopsy involves a wide incision through the skin in order to expose the suspicious mass so that a tissue sample can be removed and analyzed in a laboratory. […] A percutaneous biopsy, is an effective method for making a diagnosis before surgery. […] FNAB is another type of biopsy in which a very fine needle is placed into the mass for the collection of a cell sample, and is less invasive than the percutaneous biopsy. […] Additional tests may help determine the extent or stage of osteosarcoma. X-ray examinations commonly detect bone destruction and increased bone formation caused by osteosarcoma. Computed tomography (CT) scans and bone scans using isotopes are recommended as part of the staging process to detect lung and bone metastases, respectively.

• #1 Tests for Osteosarcoma | Diagnosing Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/detection-diagnosis-staging/how-diagnosed.html

  If the tumor is in a bone, it is very important that the biopsy is done by doctors experienced in treating bone tumors. […] Proper planning of the biopsy can help prevent later complications and might reduce the amount of surgery needed later on. […] Tests looking for chromosome or gene changes in the tumor cells might also be done. These tests can help tell osteosarcoma from other cancers that look like it under the microscope, and they can sometimes help predict whether the osteosarcoma is likely to respond to treatment. […] If osteosarcoma is diagnosed, the pathologist will assign it a grade, which is a measure of how quickly the cancer is likely to grow and spread, based on how the tumor cells look.

• #1 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Osteosarcoma can be diagnosed by core needle biopsy or open surgical biopsy. It is preferable that the biopsy be performed by a surgeon skilled in the techniques of limb sparing (removal of the malignant bone tumor without amputation and replacement of bones or joints with allografts or prosthetic devices). In these cases, the original biopsy incision placement is crucial. Inappropriate alignment of the biopsy or inadvertent contamination of soft tissues can render subsequent limb-preserving reconstructive surgery impossible. […] […] Overall survival (OS) for patients treated with surgery alone was statistically inferior. […] […] The prognosis for patients with metastatic disease appears to be determined largely by site(s) of metastases, number of metastases, and surgical resectability of the metastatic disease. […]

• #1 Diagnosis of Osteosarcoma

  https://www.medindia.net/health/conditions/diagnosis-of-osteosarcoma.htm

  Blood tests like- Complete Blood Counts, ESR or Erythrocyte Sedimentation Rate, Calcium levels, Alkaline phosphatise levels and Screening for multiple myeloma should be part of the diagnostic work up. […] Once this is done, a biopsy of the tumour to study the microscopic appearance for the final diagnosis is done. Open biopsy or a needle biopsy can be done. […] Ideally, image guided biopsies are preferred and biopsies should be performed at the centre responsible for further surgical management.

• #1 Osteosarcoma: A Review of Diagnosis, Management, and Treatment Strategies – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/october-2010/osteosarcoma-a-review-of-diagnosis-management-and-treatment-strategies/

  Imaging studies include plain radiographs of the involved bone and adjacent joint. […] Biopsies should be performed at a tertiary care medical center with experience in sarcoma diagnosis and treatment. […] The biopsy should be performed as the final step in the staging process, after imaging studies have been reviewed and considered by the multidisciplinary sarcoma team. […] Surgical staging is performed using the Musculoskeletal Tumor Society staging scheme, originally developed and described by Enneking. […] The role of positron emission tomography (PET) in the setting of osteosarcoma continues to evolve. […] The value of chemotherapy for the treatment of osteosarcoma has been clearly proven in randomized clinical trials. […] Current systemic chemotherapy treatment typically consists of cisplatin, doxorubicin, and high-dose methotrexate. […] The challenge in osteosarcoma stems from the extreme variability of one tumor to the next, making it unlikely that a single-target approach would be able to address all or even a majority of patients.

• #1 Osteosarcoma | Diagnosis & Treatment | UH Rainbow Babies & Children’s Hospital | University Hospitals | Cleveland, Ohio | University Hospitals

  https://www.uhhospitals.org/rainbow/services/pediatric-cancer-and-blood-disorders/conditions-and-treatments/osteosarcoma/diagnosis-and-treatments

  If the results of imaging tests strongly suggest that a patient has osteosarcoma or some other type of bone cancer, a biopsy (the removal of some of the tumor for viewing under a microscope and further testing) will be performed. […] A pathologist tests the biopsy samples. If osteosarcoma is diagnosed, the pathologist will assign the tumor a grade, which is a measurement of how quickly the cancer is likely to grow and spread based on the appearance of the tumor cells. […] Though not used to diagnose osteosarcoma, blood tests may be ordered once a diagnosis is made to help gauge the advancement of the osteosarcoma and to provide the doctor with a profile of a persons overall health. Blood tests are also used to monitor a persons health while they receive chemotherapy.

• #1 Diagnosis for Osteosarcoma | American Oncology Institute

  https://www.americanoncology.com/cancer-we-treat/diagnosis/osteosarcoma

  Diagnosis of osteosarcoma can be made through the following techniques: […] Medical history and physical examination: Patients may experience the symptoms of osteosarcoma for a considerable period, generally for weeks or months, before the patients seek consultation from the orthopedics. During the consultation, the patients undergo a comprehensive evaluation of signs and symptoms to determine the cause. Sometimes the patients also have to undergo complete body evaluation to find symptoms in the organs other than bones to determine the spread of the disease. […] Blood tests: No blood test is sufficient to diagnose osteosarcoma. However, blood tests assist in determining the overall health of various body organs, including bones. The patients may undergo tests to detect the levels of biochemical markers, such as lactate dehydrogenase and alkaline phosphatase. The patients may have elevated alkaline phosphatase levels due to increased activity of osteoblasts, which may be possible because of osteosarcoma. Very high alkaline phosphatase levels indicate a very high tumor burden, possibly lowering the chances of favorable outcomes. Evaluation of tumor biomarkers may also be evaluated during the treatment.

• #1

  https://www.nhs.uk/conditions/bone-cancer/diagnosis/

  If the results of the biopsy confirm or suggest bone cancer, it’s likely you’ll have further tests to assess how far the cancer has spread. […] An MRI scan is an effective way of assessing the size and spread of any cancerous tumour in or around the bones. […] CT scans are often used to check if the cancer has spread to your lungs. […] A bone scan can give more detailed information about the inside of your bones than an X-ray. […] If you have a type of bone cancer called Ewing sarcoma, you may have a test called a bone marrow biopsy to check if the cancer has spread to the bone marrow. […] Once these tests have been completed, it should be possible to tell you what stage and grade the bone cancer is. […] Staging is a description of how far a cancer has spread and grading is a description of how quickly the cancer is likely to spread in the future. […] Most cases of stage 1 bone cancer and some stage 2 bone cancers have a good chance of being cured. […] Unfortunately, stage 3 bone cancer is more difficult to cure, although treatment can relieve symptoms and slow the spread of the cancer.

• #1 Bone Cancer Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/bone-cancer/bone-cancer-diagnosis.html

  Your doctor will decide which type of biopsy is best for you based on several factors, including the type and location of the tumor. If possible, the surgeon who performs the biopsy should also do the surgery to remove the cancer. […] If you are diagnosed with bone cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis). […] One system that is used to stage all bone cancer is the American Joint Commission on Cancer (AJCC) system. […] After the T, N and M stages and the grade of the bone cancer have been determined, the information is combined and expressed as an overall stage. The process of assigning a stage number is called stage grouping. […] Even though the AJCC staging system is widely accepted and used for most cancers, bone cancer specialists tend to simplify the stages into localized and metastatic. Localized includes stages I, II and III, while metastatic is stage IV.

• #1 Osteosarcoma Diagnosis

  https://tamc.co.il/en/article/osteosarcoma-diagnosis/

  Osteosarcoma Diagnosis […] Osteosarcoma or osteogenic sarcoma refers to an aggressive malignant tumor, the cells of which consist of bone tissue. This disease is quite common, mainly male in the second decade. Often, the neoplasm is localized in the long tubular bones of the legs and hands, as well as in the bones of the pelvis, thigh, knee, elbow and skull. The tumor can also affect soft tissue, thus pathogenic cells enter the bloodstream, and metastases manifest throughout the body. […] During the disease, experts distinguish two main forms of osteosarcoma: […] Central refer to a tumor with a high degree of malignancy. […] Superficial is a formation with a low degree of malignancy and consists of bone or cartilage tissue. It is located close to the surface of the bone and does not destroy the cortical layer.

• #1 Osteosarcoma (Osteogenic Sarcoma): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15041-osteosarcoma

  Your providers might use radiation therapy to treat osteosarcoma, especially if the cancer spreads to areas where you cant have surgery. […] The survival rate depends on which type of osteosarcoma you have, and if it spreads from its original location. […] Experts estimate that 7 in 10 people survive osteosarcoma if it hasnt metastasized (spread). Survival rates for metastatic (spreading) osteosarcoma are around 5 in 10 people. […] Osteosarcoma can be aggressive. High-grade tumors can spread quickly. Lower-grade osteosarcomas will spread slowly (or not at all).

• #1 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Approximately 20% to 25% of patients with osteosarcoma present with clinically detectable metastatic disease. For patients with metastatic disease at initial presentation, roughly 20% will remain continuously free of disease, and roughly 30% will survive 5 years from diagnosis. […] […] The treatment options for UPS of bone with metastasis at initial presentation are the same as the treatment for osteosarcoma with metastasis. Patients with unresectable or metastatic UPS have a very poor outcome. […] […] Control of osteosarcoma after recurrence depends on complete surgical resection of all sites of clinically detectable metastatic disease. If surgical resection is not attempted or cannot be performed, progression and death are certain. […] […] The role of systemic chemotherapy for the treatment of patients with recurrent osteosarcoma is not well defined. The selection of further systemic treatment depends on many factors, including the site of recurrence, the patients previous primary treatment, and individual patient considerations. […]

• #1 Final Diagnosis — Case 10

  https://path.upmc.edu/cases/case10/discussion.html

  Whatever the morphologic variant and site of origin, all osteosarcomas are aggressive lesions that metastasize widely through the bloodstream, usually first to the lungs, but also to other parenchymal organs and other osseous sites. […] Approximately 30 to 40% of patients have demonstrable pulmonary metastases when first seen, and more than 90% of those who die of the neoplasm have metastases to the lungs, bones, brain, and elsewhere. […] The presenting clinical complaints are those of pain, tenderness, and swelling of the affected parts. […] The serum alkaline phosphatase level may be elevated but is usually of no diagnostic significance. […] However, in almost all cases, biopsy of these neoplasms is necessary to confirm the diagnosis before radical surgical procedures are performed. […] Advances in treatment have substantially improved the prognosis. […] Currently, combined surgery, radiation, and chemotherapy yield about a 60% five-year disease-free survival with a remarkably small incremental loss over the next five years.

• #1 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Patients with osteosarcoma who develop bone metastases have a poor prognosis. In one large series, the 5-year EFS rate was 11%. Patients with late solitary bone relapse have a 5-year EFS rate of approximately 30%. […] […] Patients with metastatic lung lesions as the sole site of metastatic disease should have the lung lesions resected if possible. Generally, this is performed after the administration of preoperative chemotherapy. […] […] Patients with localized osteosarcoma who undergo surgery and chemotherapy have a 5-year overall survival (OS) rate of 62% to 65%. Complete surgical resection is crucial for patients with localized osteosarcoma, but it is not sufficient as the only therapy. […] […] The prognosis is still substantially better than the prognosis for patients treated with surgery alone and no adjuvant chemotherapy. […]

• #1 Osteosarcoma – Diagnosis & Disease Information

  https://www.cancertherapyadvisor.com/ddi/osteosarcoma/

  Imaging studies of the affected area are the first step of the diagnostic workup of osteosarcoma.11 Orthogonal X-rays will often reveal distinctive, poorly marginated moth-eaten appearance of the bone.10 Other notable signs that may be seen on radiographs include a cloudy matrix of minerals, fibrous tissue, or cartilage.10 Magnetic resonance imaging can provide more detailed images of the lesion and bone and help determine the extent of bone marrow invasion.10,11 These scans can also reveal if the tumor has infiltrated nearby tissues and structures, and whether any masses are present.10 […] A biopsy and histologic analysis are necessary to confirm the diagnosis of osteosarcoma.10 According to National Comprehensive Cancer Network (NCCN) guidelines, fine-needle aspiration (FNA) or core needle biopsy are the preferred methods for diagnosing bone cancer.11 Open biopsies require surgery and general anesthesia, whereas FNA and core needle procedures are completed in an outpatient setting with local anesthesia. To reduce the risk of recurrence from residual tumor cells, the biopsy should be planned in a manner that will allow the biopsy tract to be removed with the tumor.10 Ideally, the biopsy and subsequent resection should be planned and performed by the same clinician. Histologic findings in osteosarcoma include malignant spindle or polyhedral mesenchymal cells with pleomorphic nuclei, scattered mitotic figures, and varying levels of anaplasia.10 Immature and disorganized osteoid production is a hallmark finding.10

• #1 Bone Cancer: Diagnosis and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0815/p205.html

  Primary bone cancers include osteosarcoma, Ewing sarcoma, and chondrosarcoma. They account for less than 1% of diagnosed cancers each year and are associated with significant morbidity and mortality. Timely diagnosis is challenging because of late patient presentation, nonspecific symptoms that mimic common musculoskeletal injuries, and low suspicion by physicians. Plain radiography is the preferred diagnostic test. Radiographic suspicion of a bone malignancy should prompt quick referral to a cancer center for multidisciplinary care. Osteosarcoma, the most common bone cancer, most often occurs in children and adolescents. It typically develops in the metaphysis of long bones, specifically the distal femur, proximal tibia, and proximal humerus. Metastasis to the lungs is common. Use of neoadjuvant and adjuvant chemotherapy, in combination with surgery, has improved survival rates to nearly 80% for patients with localized disease, and 90% to 95% of patients do not require limb amputation. Prognosis for osteosarcoma and Ewing sarcoma depends on the presence of metastasis, which lowers the five-year survival rate to 20% to 30%. […]

• #1 Osteosarcoma: A Multidisciplinary Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0315/p1123.html

  The treatment of osteosarcoma requires a multidisciplinary approach involving the family physician, orthopedic oncologist, medical oncologist, radiologist and pathologist. Osteosarcoma is a mesenchymally derived, high-grade bone sarcoma. It is the third most common malignancy in children and adolescents. Patients typically present with pain, swelling, localized enlargement of the extremity and, occasionally, pathologic fracture. Radiographs commonly demonstrate a mixed sclerotic and lytic lesion arising in the metaphyseal region of the involved bone. Computed tomography and bone scanning are recommended to detect pulmonary and bone metastases, respectively. Long-term survival and cure rates have increased to between 60 and 80 percent in patients with localized disease. […] Family physicians and pediatricians are often the first clinicians to encounter patients with osteosarcoma. Consequently, these physicians need to be familiar with the clinical presentation and overall management of this malignancy.

• #1 Bone Cancer Diagnosis | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/bone/diagnosis

  Diagnostic radiologist David Panicek performs imaging studies that help orthopaedic surgeons and medical oncologists plan the best treatment for individuals with primary bone tumors. […] If its suspected that you have bone cancer, one of our doctors will first discuss your personal and family medical history with you. We will then perform a complete medical examination and do some tests. […] To accurately diagnose bone cancer, your doctor needs to know where its located in the body, how it appears on imaging studies, and the way the cells look under a microscope. […] A biopsy can determine where in the body the cancer began. […] One key test involves examining your blood to look for a specific enzyme that is often present at high levels when bone-forming cells are very active, called alkaline phosphatase.

• #1 Bone cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bone-cancer/diagnosis-treatment/drc-20350221

  The stages of bone cancer range from 1 to 4. A stage 1 bone cancer generally is a small cancer that is growing slowly. As the cancer grows larger or grows more quickly, the stages get higher. A stage 4 bone cancer has spread to the lymph nodes or to other parts of the body. […] Not all types of bone cancers respond to chemotherapy treatments. Chemotherapy is often used to treat osteosarcoma and Ewing sarcoma. It’s not often used for chondrosarcoma. […] Radiation therapy may be an option for treating Ewing sarcoma. It’s not often used to treat chondrosarcoma or osteosarcoma. […] Bone cancer is often treated by a team of specialists that may include: […] Preparing a list of questions can help you make the most of your time. List your questions from most important to least important in case time runs out. For bone cancer, some basic questions to ask include: […] What type of bone cancer do I have? […] What is the stage of my bone cancer? […] What are the treatment options for my bone cancer? […] What are the chances that treatment will cure my bone cancer?

• #1 Osteosarcoma (Osteogenic Sarcoma) | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26391

  The NCCN advises clinicians to refer patients to a tertiary care center with osteogenic sarcoma specialists and interprofessional teams for optimal management of this condition. […] The utility of neoadjuvant chemotherapy has been attributed to subclinical micrometastatic disease. […] The goal of surgical resection is a negative margin or R0 resection in which no tumor at the edges of the resection are present. […] Limb salvage surgery is completed in about 75% of osteosarcoma cases. […] Amputation, previously considered the gold standard for surgical management of osteosarcoma, is typically reserved only for nonresectable masses with contamination of myotendinous and neurovascular that make limb salvage impossible. […] Osteosarcoma cells are assumed to be relatively radioresistant, so radiotherapy is not routinely utilized to treat osteosarcoma.

• #1 Diagnosing Bone Cancer and Soft Tissue Sarcoma | Bone and Musculoskeletal Cancer | Henry Ford Health – Detroit, MI

  https://www.henryford.com/services/bone-cancer/diagnosis

  Effective treatment for bone cancer or soft tissue sarcoma starts with an accurate diagnosis. […] During diagnosis, we find out: […] We may use one or more of these diagnostic imaging techniques to detect bone cancer and soft tissue sarcoma, including: […] We use biopsy to confirm a cancer diagnosis and find out how quickly cancer cells are growing. […] Henry Ford pathologists can quickly analyze and diagnose tissue samples while you’re still in the operating room. […] Once we diagnose cancer, your doctor explains your treatment options and works with you to create a personalized treatment plan. […] We may recommend genetic testing for bone cancer if you have a family history of one of these conditions: […] Noncancerous bone conditions, including Pagets disease or osteochondroma, can also increase your risk of developing osteosarcoma, a type of bone cancer. […] Genetic testing can detect the genes that cause these conditions: […] Talk with a doctor to find out if you should have genetic testing.

• #1 Differential Diagnosis of Osteogenic Tumors in the Context of Osteosarcoma | IntechOpen

  https://www.intechopen.com/chapters/67824

  The exact cause of osteosarcoma is unknown. However, a number of risk factors, like genetic predisposition, some existing (Paget disease, fibrous dysplasia, enchondromatosis, and hereditary multiple exostoses and retinoblastoma) bone diseases, environmental risk factors, and radiations, have been identified. […] This malignant tumor can arise from any bone, mainly usually in the metaphyseal (growth plates) long bones of the extremities, but the jaw, pelvis, and ribs may be the sites of origin. […] Osteosarcoma is very rare in young children (0.5 cases per million per year in children 5 years). However, the incidence increases steadily with age. […] It can affect all ages, but 75% appears in young age, it can affect all bones most commonly in metaphysis of long bones, and knee joint is commonly involved (60%).

• #1 Differential Diagnosis of Osteogenic Tumors in the Context of Osteosarcoma | IntechOpen

  https://www.intechopen.com/chapters/67824

  Primary bone tumors are rare, but osteosarcoma (OS) is the fourth commonest non-hematological primary neoplasm of the bone in the adolescence, and the other three commonest neoplasms, in descending order, are leukemia, brain tumors, and lymphoma. […] These tumors cannot be diagnosed without the help of radiology. […] If the bone tumors are viewed by clinical, radiological, and histopathological perspectives, the correct diagnosis can be made easily. […] The exact cause of osteosarcoma is unknown. However, a number of risk factors, like genetic predisposition, some existing bone diseases, environmental risk factors, and radiations, have been identified. […] The histological pictures of bone tumors alone are not enough to make a differentiation between osteosarcoma and benign tumors or other malignancies of the bone; therefore, radiological and clinical help is needed to make the final diagnosis of osteogenic sarcoma.

• #1 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Patients with UPS of bone are treated according to osteosarcoma treatment protocols. The outcome for patients with resectable UPS is similar to the outcome for patients with osteosarcoma. […] […] The treatment of osteosarcoma also depends on the histological grade, as follows: Low-grade osteosarcoma can be treated successfully by wide surgical resection alone, regardless of site of origin. […] […] Patients with high-grade osteosarcoma require surgery and systemic chemotherapy. This treatment is necessary whether the tumor arises in the conventional central location or on a bone surface. […] […] The site of the primary tumor is a significant prognostic factor for patients with localized disease. Among extremity tumors, distal sites have a more favorable prognosis than do proximal sites. […]

• #1 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Resectability of the tumor is a critical prognostic feature. Complete resection of the primary tumor and any skip lesions with adequate margins is generally considered essential for cure. […] […] Most treatment protocols for osteosarcoma use an initial period of systemic chemotherapy before definitive resection of the primary tumor (or resection of sites of metastases). The pathologist assesses necrosis in the resected tumor. Patients with at least 90% necrosis in the primary tumor after induction chemotherapy have a better prognosis than do patients with less necrosis. […] […] Patients with undifferentiated pleomorphic sarcoma (UPS) of bone are treated according to osteosarcoma treatment protocols. A sarcoma-specific survival rate of 70.7% has been reported using primarily cisplatin- and doxorubicin-based regimens. […]

• #1 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  In general, prognostic factors for osteosarcoma have not been helpful in identifying patients who might benefit from treatment intensification or who might require less therapy while maintaining an excellent outcome. […] […] Dramatic improvements in survival have been achieved for children and adolescents with cancer. Between 1975 and 2020, childhood cancer mortality decreased by more than 50%. For osteosarcoma, the 5-year relative survival rate increased over the same time from 40% to 72% in children younger than 15 years and from 56% to approximately 71% in adolescents aged 15 to 19 years. However, there has been no substantial improvement since the 1980s. […] […] The natural history of osteosarcoma has not changed over time, and fewer than 20% of patients with localized, resectable primary tumors treated with surgery alone can be expected to survive free of relapse. […]

• #1 Circulating biomarkers in osteosarcoma: new translational tools for diagnosis and treatment | Oncotarget

  https://www.oncotarget.com/article/19852/text/

  Liquid biopsy offers remarkable advantages over traditional tissue biopsy, however researchers need to elaborate accurate and reproducible blood tests for routine clinical practice. […] Despite the rapid development and use of multi-agent chemotherapy regimens, chemoresistance remains the major cause of treatment failure in the management of OS; thus, an early diagnosis of OS, as well as the identification of effective biomarkers predictive of chemoresistance remain crucial for timely and appropriate treatments. […] The identification of prognostic factors remains a challenge of OS treatment; indeed, the prognostic significance of biomarkers proposed to date is still controversial among the orthopaedic oncologists. […] In alternative, liquid biopsy represents a non-invasive and time-saving approach that may provide crucial information on early detection, therapeutic decision and response to therapy in OS. […] In spite of several attempts to propose blood-based biomarkers for the clinical management of OS, few biomarkers have already been validated in statistically significant prospective trials.

• #1 Circulating biomarkers in osteosarcoma: new translational tools for diagnosis and treatment | Oncotarget

  https://www.oncotarget.com/article/19852/text/

  Osteosarcoma (OS) is a rare primary malignant bone tumour arising from primitive bone-forming mesenchymal cells, with high incidence in children and young adults, accounting for approximately 60% of all malignant bone tumours. […] Diagnosis of primary lesions and recurrences is achieved by using radiological investigations and standard tissue biopsy, the latter being costly, painful and hardly repeatable for patients. […] Therefore, despite some recent advances, novel biomarkers for OS diagnosis, prediction of response to therapy, disease progression and chemoresistance, are urgently needed. […] In this regard, liquid biopsy potentially represents an alternative and non-invasive method to detect tumour onset, progression and response to therapy. […] The diagnosis of OS includes a set of clinical analyses, radiological investigations and the evaluation of the pathological tissue by performing biopsy.

• #1 Circulating biomarkers in osteosarcoma: new translational tools for diagnosis and treatment | Oncotarget

  https://www.oncotarget.com/article/19852/text/

  Currently, the analysis of bioptic tissues from primary lesions remains the gold standard to gain essential information on diagnosis, prognosis, prediction of response or resistance to treatment. […] In contrast to conventional biopsy, liquid biopsy of tumour components in blood represents a simple and rapid test, easily performed and requiring small amount of sample (usually 10-15 ml of blood), potentially opening new possibilities for cancer characterization and management. […] Liquid biopsy can be performed to detect circulating tumour microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), circulating tumour cells (CTCs), circulating tumour DNA (ctDNA), and microvesicles/exosomes released into the blood from malignant cells. […] Such novel approach does not require surgical biopsy, but still provides clinicians with a wide range of information, including tumour origin, staging, patients response to therapy and emergence of drug resistance.

• #1 Deep Learning Approaches to Osteosarcoma Diagnosis and Classification: A Comparative Methodological Approach

  https://www.mdpi.com/2072-6694/15/8/2290

  Osteosarcoma is a rare form of bone cancer that primarily affects children and adolescents during their growth years. Known to be one of the most aggressive tumors, its 5-year survival rate ranges from 27% to 65% across all age groups. […] Despite recent progress in diagnostic methods, histopathology remains the gold standard for disease staging and therapy decisions. […] In the case of OS, microscopic examination facilitates the estimation of tumor differentiation, invasion, and the presence of necrosis. Still, microscopy is a lengthy, tedious process that is prone to observer bias. […] Automating the histopathological evaluation of OS could result in more accurate, fast, and cost-effective examinations. […] Machine learning approaches are the current state-of-the-art (SotA) method for image classification.

• #1 Multimodal Imaging of Osteosarcoma: From First Diagnosis to Radiomics

  https://www.mdpi.com/2072-6694/17/4/599

  Despite the challenges in diagnosing osteosarcoma due to nonspecific symptoms, radiological overlap with benign conditions, and the tumor’s complexity, multi-modal imaging approaches—combining X-ray (XR), MRI, CT, and PET—have significantly improved early detection and characterization. Additionally, AI-driven analysis enhances early detection by identifying subtle patterns that may be missed on conventional X-rays, particularly malignant features. The complementary information provided by integrating MRI and CT allows for a more comprehensive evaluation of the tumor’s extent, heterogeneity, relationship with adjacent structures, and potential metastasis, including skip metastases, thus improving diagnosis and staging.

• #1

  https://link.springer.com/article/10.1007/s13755-024-00288-5

  Early and accurate diagnosis of osteosarcomas (OS) is of great clinical significance, and machine learning (ML) based methods are increasingly adopted. […] In this paper, we seek to explore the capability of deep learning models in diagnosing primary OS, with higher accuracy, explainability, and generality. […] We evaluate this model on real-world clinic data with 848 patients aged from 4 to 81. […] The experimental results reveal the effectiveness of incorporating ALP and LDH simultaneously in a late fusion approach, with the accuracy of the considered 2608 cases increased to 97.17%, compared to 94.35% in the baseline. […] Grad-CAM visualizations consistent with orthopedic specialists further justified the models explainability.

• #1 Osteosarcoma differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Osteosarcoma_differential_diagnosis

  Osteosarcoma must be differentiated from other diseases such as: any type of bone lesions caused by infection and/or tumors. […] Osteosarcoma must be differentiated from: Osteomyelitis, Pediatric Osteomyelitis, Rhabdomyosarcoma, Pediatric Rhabdomyosarcoma, Chondrosarcoma, Metastases from other malignancies, Fibrous dysplasia, Giant cell tumors, Ewing’s sarcoma, Malignant fibrous histiocytoma, Lymphoma Osteoblastoma, Aneurysmal bone cyst, Fibrosarcoma and Cortical desmoid. […] Pediatric osteosarcoma is the second most common primary bone tumor. […] Primary osteosarcoma occurs in age of 10-20 years old. […] Secondary osteosarcoma occurs in older patients and is secondary to paget disease and bone infarcts. […] Radiography: Osteolytic/ osteoblastic feature. […] CT scan: Primary lesion and chest CT are required. […] MRI: Exact assessment of tumor extension.

• #2 Osteosarcoma | Diagnosis & Treatment | UH Rainbow Babies & Children’s Hospital | University Hospitals | Cleveland, Ohio | University Hospitals

  https://www.uhhospitals.org/rainbow/services/pediatric-cancer-and-blood-disorders/conditions-and-treatments/osteosarcoma/diagnosis-and-treatments

  Osteosarcoma is usually discovered because a person exhibits certain signs or symptoms, such as swelling or pain in a bone or joint, that prompts a visit to the doctor. If the doctor suspects a bone sarcoma after completing a medical history and performing a physical exam of the patient, other testing is required to confirm the diagnosis. […] This includes one or more of the following: […] Imaging tests, including: […] X-ray: An X-ray is a type of energy beam that can pass through the body and onto a film to make a picture of areas inside the body. X-rays will be taken of the chest and the area where the tumor is located. […] MRI scan: This procedure uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body. Your child is not exposed to radiation during an MRI.

• #2 Bone Cancer: Diagnosis and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0815/p205.html

  Because of the aggressive nature of bone cancers, early diagnosis is critical. However, delays in diagnosis are common. In the absence of trauma or known injury, a patient’s perception of symptoms may not elicit initial concern. Bone cancers can also present with relapsing and remitting symptoms, including pain and fever. […]

• #2 Osteosarcoma (Osteogenic Sarcoma) | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26391

  Osteosarcoma, or osteogenic sarcoma, is the most common primary malignant bone tumor, accounting for approximately 20% of all cases. Osteosarcoma demonstrates a bimodal age distribution and most commonly occurs in the extremities. Approximately 75% of osteosarcoma diagnoses occur in patients less than 25 years of age; the average at diagnosis is 20 years. […] The most common presenting symptom of osteosarcoma is bone pain, initially with activity and then at rest. […] Lesions are typically identified on radiographs of the affected limb; magnetic resonance imaging (MRI) is then utilized to characterize a lesion further, and a biopsy is required for definitive diagnosis. […] The treatment of osteosarcoma typically requires some combination of wide excision, chemotherapy, and radiotherapy.

• #2 Osteosarcoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteosarcoma/diagnosis-treatment/drc-20351053

  Osteosarcoma diagnosis may begin with a physical exam. Based on the findings of the exam, there might other tests and procedures. […] Imaging tests make pictures of the body. They can show the location and size of an osteosarcoma. Tests might include: X-ray, MRI, CT, Bone scan, Positron emission tomography scan, also called a PET scan. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. The tissue might be removed using a needle that is put through the skin and into the cancer. Sometimes surgery is needed to get the tissue sample. The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Your healthcare team uses this information to make a treatment plan. […] Determining the type of biopsy needed and how it should be done requires careful planning by the medical team. The biopsy needs to be done so that it won’t get in the way of future surgery to remove the cancer. Before having a biopsy, ask your healthcare professional to refer you to a team of experts who have experience treating osteosarcoma.

• #2 Diagnosis for Osteosarcoma | American Oncology Institute

  https://www.americanoncology.com/cancer-we-treat/diagnosis/osteosarcoma

  X-rays: Once the patients are suspected of having bone mass, tumor, or osteosarcoma, they are advised to undergo a radiographic examination. The results of the radiographic examination may reveal bone destruction. The other characteristic features of the radiographic results in osteosarcoma are cloud-like lesions and osteoid matrix calcification due to the tumor. […] Magnetic resonance imaging: It is a preferred imaging modality in diagnosing osteosarcoma. The technique further characterizes the presence of lesions identified during radiographic examination. MRI also assists in detecting the spread of tumors inside and outside the bone. The radiologists generally involve one joint above and below the affected bone to avoid skipping the lesions. MRI also provides valuable information about the spread of the tumor to surrounding soft tissues, neurovascular bundles, and joint involvement.

• #2 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Osteosarcoma can be diagnosed by core needle biopsy or open surgical biopsy. It is preferable that the biopsy be performed by a surgeon skilled in the techniques of limb sparing (removal of the malignant bone tumor without amputation and replacement of bones or joints with allografts or prosthetic devices). In these cases, the original biopsy incision placement is crucial. Inappropriate alignment of the biopsy or inadvertent contamination of soft tissues can render subsequent limb-preserving reconstructive surgery impossible. […] […] Overall survival (OS) for patients treated with surgery alone was statistically inferior. […] […] The prognosis for patients with metastatic disease appears to be determined largely by site(s) of metastases, number of metastases, and surgical resectability of the metastatic disease. […]

• #2 Osteosarcoma: Symptoms, Causes, Treatment, & Prognosis

  https://www.webmd.com/cancer/what-is-osteosarcoma

  Radionuclide bone scan. A technetium-99m methylene diphosphonate bone scan can help detect the spread of osteosarcoma and bone cancer. It’s a less expensive but less specific alternative to PET scans. […] Follow-up MRI or CT (both with contrast). These scans are needed if nuclear imaging finds the cancer has metastasized, or spread far outside the bone. […] Fertility consultation. Treatment for bone cancer can affect fertility.

• #2 Osteosarcoma | Diagnosis & Treatment | UH Rainbow Babies & Children’s Hospital | University Hospitals | Cleveland, Ohio | University Hospitals

  https://www.uhhospitals.org/rainbow/services/pediatric-cancer-and-blood-disorders/conditions-and-treatments/osteosarcoma/diagnosis-and-treatments

  If the results of imaging tests strongly suggest that a patient has osteosarcoma or some other type of bone cancer, a biopsy (the removal of some of the tumor for viewing under a microscope and further testing) will be performed. […] A pathologist tests the biopsy samples. If osteosarcoma is diagnosed, the pathologist will assign the tumor a grade, which is a measurement of how quickly the cancer is likely to grow and spread based on the appearance of the tumor cells. […] Though not used to diagnose osteosarcoma, blood tests may be ordered once a diagnosis is made to help gauge the advancement of the osteosarcoma and to provide the doctor with a profile of a persons overall health. Blood tests are also used to monitor a persons health while they receive chemotherapy.

• #2 Diagnosis for Osteosarcoma | American Oncology Institute

  https://www.americanoncology.com/cancer-we-treat/diagnosis/osteosarcoma

  Bone scan: Bone scan is the method to detect bony metastasis. The technique involves using radionucleotide, which is injected into the vessels and accumulated in the abnormal areas of the bone. […] Biopsy: The biopsy is a procedure that involves obtaining samples of the affected bone and sending them to the laboratory to detect the presence of cancer cells. There are several types of biopsy for osteosarcoma. These are: […] Core needle biopsy: Core needle biopsy involves using a thin, hollow needle to remove the bone tissue as a cylinder. The procedure is performed under the action of local anesthesia. If the tumor is deep inside the bone, ultrasound (ultrasound-guided biopsy) or CT scan (CT-guided biopsy) may assist in the biopsy. […] Surgical biopsy: In cases where the tumor sample is not obtained through core needle biopsy, the patients may have to undergo surgery to obtain the sample. The procedure is done under anesthesia. The skin is cut, and the sample is removed by exposing the affected bone.

• #2 Osteosarcoma: A Multidisciplinary Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0315/p1123.html

  Most conventional osteosarcomas develop in patients 10 to 20 years of age. Approximately 80 percent of these tumors are nonmetastatic at the time of presentation. A high index of suspicion for osteosarcoma enables early diagnosis, which can have a positive effect on survival. […] Radiologic studies that are recommended for evaluation of the primary tumor and detection of metastatic disease are discussed in the following sections and summarized in Table 2. […] Biopsy is the key step in the diagnosis of an osteosarcoma. Improperly performed biopsies are a frequent cause of misdiagnosis, amputation and local recurrence, and they may have a negative effect on survival. All biopsy samples should be obtained by the orthopedic oncologist who will perform the definitive procedure or by a physician directly under the oncologist’s supervision.

• #2 Osteosarcoma – Wikipedia

  https://en.wikipedia.org/wiki/Osteosarcoma

  Most times, the early signs of osteosarcoma are caught on X-rays taken during routine dental check-ups. Osteosarcoma frequently develops in the mandible (lower jaw); accordingly, dentists are trained to look for signs that may suggest osteosarcoma. Even though radiographic findings for this cancer vary greatly, one usually sees a symmetrical widening of the periodontal ligament space. A dentist who has reason to suspect osteosarcoma or another underlying disorder would then refer the patient to an Oral Maxillofacial surgeon for biopsy. A biopsy of suspected osteosarcoma outside of the facial region should be performed by a qualified orthopedic oncologist. The American Cancer Society states: „Probably in no other cancer is it as important to perform this procedure properly. An improperly performed biopsy may make it difficult to save the affected limb from amputation.”

• #2 Bone Cancer Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/bone-cancer/bone-cancer-diagnosis.html

  Your doctor will decide which type of biopsy is best for you based on several factors, including the type and location of the tumor. If possible, the surgeon who performs the biopsy should also do the surgery to remove the cancer. […] If you are diagnosed with bone cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis). […] One system that is used to stage all bone cancer is the American Joint Commission on Cancer (AJCC) system. […] After the T, N and M stages and the grade of the bone cancer have been determined, the information is combined and expressed as an overall stage. The process of assigning a stage number is called stage grouping. […] Even though the AJCC staging system is widely accepted and used for most cancers, bone cancer specialists tend to simplify the stages into localized and metastatic. Localized includes stages I, II and III, while metastatic is stage IV.

• #2 Tests for bone cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bone-cancer/getting-diagnosed/tests-bone-cancer

  You usually have a number of tests to check for cancer that starts in the bones. Bone cancer is also called bone sarcoma. […] Your GP can do some tests to help them decide if you need to see a specialist. This usually includes: a physical examination, an x-ray, blood tests. […] Your specialist usually does more tests. These might include: MRI scan, CT scan, taking a sample of bone tissue called a bone biopsy, a bone marrow biopsy, bone scan, PET-CT scan, PET-MRI scan, genetic tests on your cancer cells, other blood tests. […] A biopsy is where a surgeon takes a small sample of bone from the abnormal area. They send it to the laboratory. A specialist doctor called a pathologist looks at the sample under a microscope. It is the only way to find out for sure if you have bone cancer. […] The ALP level is sometimes raised in people with osteosarcoma.

• #2 Osteosarcoma (Osteogenic Sarcoma) | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26391

  Approximately 10% to 20% of patients with osteosarcoma have evidence of metastases at their initial presentation; the most common metastatic site is the lungs. […] The National Comprehensive Cancer Network (NCCN) recommends diagnostic laboratory, imaging, and histological studies following the initial clinical assessment. […] Serum tests, including a complete blood count, alkaline phosphatase (ALP), and lactate dehydrogenases (LDH), are assessed in the initial workup because they provide evidence for diagnosis and prognosis. […] The following imaging modalities are preferred for evaluation of osteosarcoma: Radiographs of the entire bone affected should be obtained. […] A biopsy is necessary after the physical exam, laboratory analysis, and diagnostic imaging confirm the presence of a lesion consistent with osteosarcoma.

• #2 Osteosarcoma Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1256857-workup

  A CT scan of the primary lesion and a CT scan of the chest (high resolution) should be obtained. CT of the primary lesion helps delineate the location and extent of the tumor and is critical for surgical planning. […] MRI of the primary lesion is the best method of assessing the extent of intramedullary disease, as well as associated soft-tissue masses and skip lesions. This imaging modality is perhaps the single most important study for accurate surgical staging of the lesion with use of the Enneking staging system. […] Two elements are important to the histologic examination of the tumor. The first, tumor type, can be assessed on the biopsy. The second, response to treatment, can be assessed on the definitive resection following chemotherapy. […] The purpose of staging tumors is to stratify risk groups. The conventional staging used for other solid tumors is not appropriate for skeletal tumors, because these tumors rarely involve lymph nodes or regional spread.

• #2 Osteosarcoma: A Review of Diagnosis, Management, and Treatment Strategies – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/october-2010/osteosarcoma-a-review-of-diagnosis-management-and-treatment-strategies/

  Imaging studies include plain radiographs of the involved bone and adjacent joint. […] Biopsies should be performed at a tertiary care medical center with experience in sarcoma diagnosis and treatment. […] The biopsy should be performed as the final step in the staging process, after imaging studies have been reviewed and considered by the multidisciplinary sarcoma team. […] Surgical staging is performed using the Musculoskeletal Tumor Society staging scheme, originally developed and described by Enneking. […] The role of positron emission tomography (PET) in the setting of osteosarcoma continues to evolve. […] The value of chemotherapy for the treatment of osteosarcoma has been clearly proven in randomized clinical trials. […] Current systemic chemotherapy treatment typically consists of cisplatin, doxorubicin, and high-dose methotrexate. […] The challenge in osteosarcoma stems from the extreme variability of one tumor to the next, making it unlikely that a single-target approach would be able to address all or even a majority of patients.

• #2 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Patients with UPS of bone are treated according to osteosarcoma treatment protocols. The outcome for patients with resectable UPS is similar to the outcome for patients with osteosarcoma. […] […] The treatment of osteosarcoma also depends on the histological grade, as follows: Low-grade osteosarcoma can be treated successfully by wide surgical resection alone, regardless of site of origin. […] […] Patients with high-grade osteosarcoma require surgery and systemic chemotherapy. This treatment is necessary whether the tumor arises in the conventional central location or on a bone surface. […] […] The site of the primary tumor is a significant prognostic factor for patients with localized disease. Among extremity tumors, distal sites have a more favorable prognosis than do proximal sites. […]

• #2 Osteosarcoma | Alex’s Lemonade Stand Foundation for Childhood Cancer

  https://www.alexslemonade.org/childhood-cancer/guides/childhood-cancer/chapter-2-bone-sarcomas/osteosarcoma

  A definitive diagnosis of osteosarcoma can only be made by examining part of the tumor under a microscope. A complete evaluation by the orthopedic or pediatric oncologist, including imaging studies, should be done before the initial biopsy, because a poorly performed biopsy may jeopardize the option of future limb-sparing surgery. […] Once osteosarcoma has been diagnosed, the pediatric oncologist will perform more tests to determine whether the cancer has spread to other parts of the body. […] A CT scan or MRI of the bones, a CT scan of the chest, and a nuclear bone scan can be performed to check for metastases at sites distant from the main tumor. […] At diagnosis, about 20 percent of young people with osteosarcoma have x-ray evidence of disease that has spread to other parts of the body (called metastatic disease).

• #2 Osteosarcoma – Diagnosis & Disease Information

  https://www.cancertherapyadvisor.com/ddi/osteosarcoma/

  After establishing an osteosarcoma diagnosis, clinicians need to determine if the cancer has metastasized.10 The lung is the most common site of metastasis of osteosarcoma.11 Because more than three-quarters of metastatic cases of osteosarcoma involve spread to the lungs, a chest computed tomography scan is required for all patients with osteosarcoma.10 Positron emission tomography and bone scans can offer additional information regarding both soft tissue and bone metastases.10

• #2 Bone Cancer: Diagnosis and Treatment Principles – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30215968/

  Primary bone cancers include osteosarcoma, Ewing sarcoma, and chondrosarcoma. They account for less than 1% of diagnosed cancers each year and are associated with significant morbidity and mortality. Timely diagnosis is challenging because of late patient presentation, nonspecific symptoms that mimic common musculoskeletal injuries, and low suspicion by physicians. Plain radiography is the preferred diagnostic test. Radiographic suspicion of a bone malignancy should prompt quick referral to a cancer center for multidisciplinary care. Osteosarcoma, the most common bone cancer, most often occurs in children and adolescents. It typically develops in the metaphysis of long bones, specifically the distal femur, proximal tibia, and proximal humerus. […] Prognosis for osteosarcoma and Ewing sarcoma depends on the presence of metastasis, which lowers the five-year survival rate to 20% to 30%.

• #2 Bone cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bone-cancer/diagnosis-treatment/drc-20350221

  The stages of bone cancer range from 1 to 4. A stage 1 bone cancer generally is a small cancer that is growing slowly. As the cancer grows larger or grows more quickly, the stages get higher. A stage 4 bone cancer has spread to the lymph nodes or to other parts of the body. […] Not all types of bone cancers respond to chemotherapy treatments. Chemotherapy is often used to treat osteosarcoma and Ewing sarcoma. It’s not often used for chondrosarcoma. […] Radiation therapy may be an option for treating Ewing sarcoma. It’s not often used to treat chondrosarcoma or osteosarcoma. […] Bone cancer is often treated by a team of specialists that may include: […] Preparing a list of questions can help you make the most of your time. List your questions from most important to least important in case time runs out. For bone cancer, some basic questions to ask include: […] What type of bone cancer do I have? […] What is the stage of my bone cancer? […] What are the treatment options for my bone cancer? […] What are the chances that treatment will cure my bone cancer?

• #2 Differential Diagnosis of Osteogenic Tumors in the Context of Osteosarcoma | IntechOpen

  https://www.intechopen.com/chapters/67824

  The exact cause of osteosarcoma is unknown. However, a number of risk factors, like genetic predisposition, some existing (Paget disease, fibrous dysplasia, enchondromatosis, and hereditary multiple exostoses and retinoblastoma) bone diseases, environmental risk factors, and radiations, have been identified. […] This malignant tumor can arise from any bone, mainly usually in the metaphyseal (growth plates) long bones of the extremities, but the jaw, pelvis, and ribs may be the sites of origin. […] Osteosarcoma is very rare in young children (0.5 cases per million per year in children 5 years). However, the incidence increases steadily with age. […] It can affect all ages, but 75% appears in young age, it can affect all bones most commonly in metaphysis of long bones, and knee joint is commonly involved (60%).

• #2 Bone Cancer: Symptoms, Causes, Diagnosis, Types, Treatment, and Outlook

  https://www.webmd.com/cancer/bone-tumors

  Osteosarcoma is the most common primary bone cancer. […] The earliest symptom of bone cancer is unusual pain or swelling in or around the affected area of your bone. Your doctor will refer you for imaging tests, such as X-rays to diagnose you. […] Osteosarcoma starts in the cells that build your bones called osteoblasts. It can happen in any of your bones, especially if you’re an older adult. But in children, teens, and younger adults, it often starts in your upper arm bone close to your shoulder or your leg bone close to your knee. It tends to grow fast and spread to other parts of your body, such as your lungs. […] Osteosarcoma in particular seems to be more common in people who have had treatment with high-dose external radiation therapy or chemotherapy with an alkylating agent, especially as children.

• #2 Osteosarcoma (Osteogenic Sarcoma) | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26391

  Chemotherapy is also the standard of care for high-grade osteogenic sarcoma, given in the neoadjuvant and adjuvant setting. […] The 5-year overall survival rate for localized osteosarcomas went from 10% to 20% to about 70%. […] Various factors can affect the prognosis of osteosarcoma, including location, primary tumor size, metastatic disease, surgical resection margin, chemotherapy response, age, and histological subtype.

• #2

  https://tumorsurgery.org/tumor-education/bone-tumors/types-of-bone-tumors/telangiectatic-osteosarcoma.aspx

  Telangiectatic osteosarcomas have a variable gross appearance. […] Its gross appearance can mimic an aneurysmal bone cyst. […] Telangiectatic osteosarcoma has a similar prognosis as conventional osteosarcoma. […] Overall 5-year survival rate depends on site, size, resectability, presence of metastasis. […] There is approximately an overall 65% 5 year survival rate for patients who present without overt metastases. […] Patients who respond well to preoperative chemotherapy have a better prognosis than those who have a poor response. […] Patients who present with or develop metastases have a worse prognosis.

• #2 Circulating biomarkers in osteosarcoma: new translational tools for diagnosis and treatment | Oncotarget

  https://www.oncotarget.com/article/19852/text/

  Currently, the analysis of bioptic tissues from primary lesions remains the gold standard to gain essential information on diagnosis, prognosis, prediction of response or resistance to treatment. […] In contrast to conventional biopsy, liquid biopsy of tumour components in blood represents a simple and rapid test, easily performed and requiring small amount of sample (usually 10-15 ml of blood), potentially opening new possibilities for cancer characterization and management. […] Liquid biopsy can be performed to detect circulating tumour microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), circulating tumour cells (CTCs), circulating tumour DNA (ctDNA), and microvesicles/exosomes released into the blood from malignant cells. […] Such novel approach does not require surgical biopsy, but still provides clinicians with a wide range of information, including tumour origin, staging, patients response to therapy and emergence of drug resistance.

• #2

  https://link.springer.com/article/10.1007/s13755-024-00288-5

  Early and accurate diagnosis of osteosarcomas (OS) is of great clinical significance, and machine learning (ML) based methods are increasingly adopted. […] In this paper, we seek to explore the capability of deep learning models in diagnosing primary OS, with higher accuracy, explainability, and generality. […] We evaluate this model on real-world clinic data with 848 patients aged from 4 to 81. […] The experimental results reveal the effectiveness of incorporating ALP and LDH simultaneously in a late fusion approach, with the accuracy of the considered 2608 cases increased to 97.17%, compared to 94.35% in the baseline. […] Grad-CAM visualizations consistent with orthopedic specialists further justified the models explainability.

• #2 Imaging diagnosis and differential diagnosis of extraskeletal osteosarcoma | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-11731-3

  Although the imaging manifestations of EOS lack specificity, calcification and ossification are important manifestations. Calcification or ossification has been reported to occur in approximately 50% of cases of EOS. […] On MRI, most of the masses had relatively clear boundaries, and some of them had complete or incomplete capsules. […] EOS needs to be differentiated from a variety of soft tissue osteoblastic lesions, including myositis ossificans, dermatomyositis with ossification, and a variety of soft tissue tumours, such as extraskeletal chondrosarcoma, synovial sarcoma, undifferentiated pleomorphic sarcoma, fibrosarcoma, and liposarcoma. […] The prognosis of EOS is generally poor, and recurrence and metastasis are common, among which the lungs are the most common site for recurrence, followed by lymph nodes, liver, bone, soft tissue, etc.

• #2 Classic Osteosarcoma Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/393927-overview

  The National Comprehensive Cancer Network (NCCN) recommends that the initial workup for osteosarcoma include imaging of the primary site by MRI with or without CT scanning and chest imaging, including chest CT and head-to-toe PET/CT scan and/or bone scan. More detailed imaging of abnormalities identified on primary imaging by CT or MRI is required when metastatic disease is suspected. […] MRI is the most important imaging technique for the accurate local staging of osteosarcoma; in addition, it assists in determining the most appropriate surgical management. For the purposes of staging, assessment of the relationship of a tumor to the anatomic compartment in which it originated and to other adjacent compartments is of vital importance. […] The assessment of the extent of extraosseous tumor involves a determination of which muscle compartments are involved and of the relationship of the tumor to neurovascular structures and adjacent joints.

• #2 Osteosarcoma: A Multidisciplinary Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0315/p1123.html

  The treatment of osteosarcoma requires a multidisciplinary approach involving the family physician, orthopedic oncologist, medical oncologist, radiologist and pathologist. Osteosarcoma is a mesenchymally derived, high-grade bone sarcoma. It is the third most common malignancy in children and adolescents. Patients typically present with pain, swelling, localized enlargement of the extremity and, occasionally, pathologic fracture. Radiographs commonly demonstrate a mixed sclerotic and lytic lesion arising in the metaphyseal region of the involved bone. Computed tomography and bone scanning are recommended to detect pulmonary and bone metastases, respectively. Long-term survival and cure rates have increased to between 60 and 80 percent in patients with localized disease. […] Family physicians and pediatricians are often the first clinicians to encounter patients with osteosarcoma. Consequently, these physicians need to be familiar with the clinical presentation and overall management of this malignancy.

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