Obligatory medical device diagnostics.
- Conventional radiography of the affected body region, in two planes – to assess the extent of tumor growth and, if necessary, skip metastases (nearby daughter tumors); that is, the entire affected bone and adjacent joint regions should be assessed
- Computed tomography (CT; sectional imaging procedure (X-ray images 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).
- Magnetic resonance imaging (MRI; computer-assisted cross-sectional imaging method (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 (vertebral canal)?)
- If necessary, positron emission tomography (PET; nuclear medicine procedure that allows the creation of cross-sectional images of living organisms by visualizing the distribution patterns of weak radioactive substances) – as a baseline examination to assess the response to therapy.
Diagnosis of spread (“staging”) (metastasis?) – if the suspected diagnosis of osteosarcoma is confirmed.
- Computed tomography of the thorax (thoracic CT) – to detect distant metastases in the lungs.
- X-ray of the thorax (X-ray thorax/chest), in two planes – for detection of distant metastases in the lungs.
- 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 distant 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.