Obligatory medical device diagnostics.
- Conventional radiography of the affected body region and adjacent joints, in two planes-to assess the extent of tumor growth; show (see “Lodwick classification” below):
- Computed tomography (CT; sectional imaging procedure (X-ray images from different directions with computer-based analysis)) – 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.
- Positron emission tomography (PET), if necessary – as a baseline examination to assess response to therapy.
Spread diagnosis (“staging”) (metastasis?) – if the suspected diagnosis of Ewing’s sarcoma is confirmed.
- Computed tomography of the thorax (chest 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 | |||
|
Very slow growing | Sclerosis (pathological hardening of here: tissues) and sharp boundary | benign | Chondroblastoma, enchondroma, fibrous bone dysplasia, nonossifying fibroma, osteoid osteoma |
|
Slow growing (displacing) | Bone distention > 1 cm and/or no sclerosis | actively benign | Giant cell tumor |
|
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.
