This document discusses the approach to diagnosing and treating bone tumors. It covers the three pillars of diagnosis: clinical examination and history, radiology including x-rays and MRI, and histopathological examination (HPE) via biopsy. Key aspects of radiology covered are lesion characteristics, surgical staging, guided biopsy, and follow up. HPE is described as the gold standard for determining the exact nature and approach to the tumor. Overall management involves clinical and radiological staging, histological diagnosis via biopsy, and treatment which may include surgery, radiation therapy, and chemotherapy.

1. Approach to Bone Tumor
Dr GB sir
Department of Orthopaedic

2. Diagnosis
Staging
Management

3. Diagnosis
Clinical
Radiology Histology

4. 1st Pillar - Clinical
History
• Pain and swelling
• Duration
• Onset and progression
• Remission
• Other joint/ organ involvement

5. 1st Pillar - Clinical
Examination
Swelling:
• Numbers
• Shape – oval/ round/ diffuse
• Size
• Borders – well defined/ ill defined
• Surface – smooth/ irregular/ lobulated
• Consistency – firm/ cystic/ hard/ bony hard
• Plane – superficial/ deep
• Others special features

6. 2nd Pillar: Radiology
• X- ray and CT
• MRI
• CT angiogram
• PET scan/ Bone scan
• Ultrasound
Role of Imaging
 Lesion Characterisation
 Surgical Staging
 Image guided biopsy
 Response to chemoterapy
 Follow-up

7. 2nd Pillar: Radiology
• Age
• Location
• Morphology
• Zone of transition
• Periosteal reaction

9. Morphology
Lytic
Well - defined
Ill - defined
sclerotic

11. Zone of transition
• look at the zone of transition between the lesion and
the adjacent normal bone.
• The zone of transition is the most reliable indicator in
determining whether an osteolytic lesion is benign or
malignant.
• The zone of transition only applies to osteolytic
lesions since sclerotic lesions usually have a narrow
transition zone.

12. Zone of transition
Small zone of transition
• A small zone of transition results in a sharp, well-
defined border and is a sign of slow growth.
• A sclerotic border especially indicates poor biological
activity.

13. Zone of transition
Wide zone of transition
• An ill-defined border with a broad zone of transition
is a sign of aggressive growth (1).
• It is a feature of malignant bone tumors

14. Periosteal reaction
• A periosteal reaction is a non-specific reaction and
will occur whenever the periosteum is irritated by a
malignant tumor, benign tumor, infection or trauma.
• There are two patterns of periosteal reaction: a
benign and an aggressive type.

18. 3rd pillar: HPE
• Performed only at the conculsion of imaging
work up.
 Helps determine the exact anatomic
approach to the tumor.
 Specifies the region of the tumor that
represents the underlying diseases.
 Biopsy can later the interpretation of the
imaging studies.

19. BIOPSY IS THE GOLD
STANDARD

20. Types of Biopsy
Biopsy
Bone Soft tissue

21. Types of Biopsy
Biopsy
Closed
Fine
needle
Core
needle
Open
Incisional Excisional Primary
wide
excisional

25. Diagnosis
Staging
Management
Clinical
Radiological – X ray/ MRI/ CT
Histology - Biopsy
CT Thorax/ Bone scan/ PET scan
Surgical/ Conservative
Radiation therapy
Chemotherapy