Bone Tumors: Diagnostic Tests

Mandatory medical device diagnostics.

  • Sonography (ultrasound examination)
  • Conventional X-ray of the affected body region, in two planes – to assess the extent of tumor growth and possibly also the type, as well as its dignity (biological behavior of tumors; i.e., whether they are benign (benign) or malignant (malignant)); blurred defects in the bone substance indicate a malignant bone tumor
  • Computed tomography (CT; sectional imaging procedure (X-ray images taken from different directions with computer-based evaluation)) – for the purpose of determining the location, size, and extent of the tumor (bone destruction/destruction? ), growth rate (aggressiveness), and to detect skip metastases (nearby metastases)
  • Magnetic resonance imaging (MRI; computer-assisted cross-sectional imaging (using magnetic fields, i.e., without X-rays)) – for the purpose of determining the location, size, and extent of the tumor (soft tissue infiltration? intramedullary spread in the bone marrow? Involvement of the spinal canal?) and for the detection of skip metastases (nearby metastases).
  • Bone marrow aspiration – for the purpose of molecular biological analysis to detect tumor cells in the bone marrow.
  • Angiography, if necessary – preoperatively, so highly vascularized tumors can be embolized.
  • Positron emission tomography (PET), if necessary – as a baseline examination to assess response to therapy.

Spread diagnostics (“staging”) (metastasis?) – if the suspected diagnosis of a bone tumor has been confirmed.

  • Computed tomography of the thorax (thoracic CT) – to detect distant metastases in the lungs.
  • Computed tomography (CT) of the abdomen (abdominal CT)/pelvis (pelvic CT).
  • Skeletal scintigraphy (nuclear medicine procedure that can represent functional changes in the skeletal system, in which regionally (locally) pathologically (pathologically) increased or decreased bone remodeling processes are present) – to detect metastases in other areas of the skeleton.
  • If necessary, positron emission tomography (PET) – to detect distant metastases.

Lodwick classification

By means of the Lodwick classification, it is possible to assess whether the tumor is benign (benign) or malignant (malignant) on an X-ray. Furthermore, it is suitable for the assessment of progression in the case of aggressive behavior of the tumor. An index for the growth rate of the bone tumor or an inflammatory process is the reaction visible on the X-ray, i.e. the bone structure is modified locally, regionally or diffusely by the tumor. The visible patterns of destruction are classified into the following main groups:

Grade Growth rate Bone destruction Dignity* Bone tumors
Grade I Purely geographic (circumscribed); boundary definable
  • A
Very slow growing Sclerosis (pathological hardening of here: tissues) and sharp boundary benign Chondroblastoma, enchondroma, fibrous bone dysplasia, nonossifying fibroma, osteoid osteoma
  • B
Slow growing (displacing) Bone distention > 1 cm and/or no sclerosis actively benign Giant cell tumor
  • C
Mean growth rate(locally invasive) Total compact penetration (compacta = outer marginal layer of bone). aggressive benign chondro-, osteo-, fibrosarcomas
Grade II fast growing Geographic, with moth-eaten/permeated (without respect for anatomical boundaries) component predominantly malignant Chondrosarcoma, fibrosarcoma, malignant fibrous histiocytoma, metastases, osteosarcoma
Grade III very fast growing purely moth-eaten or permeative destruction malignant Ewing’s sarcoma

* biological behavior of tumors; that is, whether they are benign (benign) or malignant (malignant)The classification is particularly suitable for tumors of a long bone or small bone. However, it is neither sensitive nor specific, so that as a rule further diagnostic measures cannot be dispensed with.