Routine diagnostic sequence for osteosarcoma

As we all know, early diagnosis is very important for the treatment and prognosis of osteosarcoma. Because the early symptoms of osteosarcoma are not easy to find, a series of examinations are required to confirm the diagnosis. Is there a sequence in the process of examination items? Let's take a detailed look at the routine diagnostic sequence of osteosarcoma.

1. Imaging examination X-ray shows bone hyperplasia, osteolytic destruction, periosteal reaction, obvious new bone hyperplasia under the periosteum, showing the typical Codman triangle (cuff sign) and soft tissue mass.

2. Pathological cytology examination: Incisional biopsy or percutaneous puncture biopsy can further clarify the diagnosis. It is generally divided into fibroblastic type, osteoblastic type, and vascular type. Lung and local X-rays are important steps in diagnosing osteosarcoma and judging the prognosis of sarcoma. The linear signs of osteosarcoma are described from the following aspects:

(I) Local soft tissue tumors: If the tumor occurs in the deep layer of the periosteum, or the tumor has broken through from the bone to the surrounding area, irregular patterns can be found in the soft tissue on the X-ray.

(II) Periosteal changes: Early periosteal changes are triangular periosteal new bone formation, followed by solar radiation-like periosteal reaction. In the late stage, as the tumor expands to the periphery, the triangular new bone also becomes defective and moves toward the middle of the bone shaft. The solar radiation-like new bone trabeculae, squeezed and destroyed by tumor cells, form a disordered state like fluffy hair. Finally, as the tumor continues to proliferate, the new bone may completely disappear, and the soft tissue may show irregular tumor shadows.

(III) Cortical bone changes: When osteosarcoma occurs in the periosteum or cortical bone itself, the earliest and most important change is mild destruction and loosening of the cortical bone on one side. If the tumor is sclerotic osteosarcoma, in addition to bone destruction and loosening, there are also irregular tumor bone hyperplasia shadows. Therefore, in the X-ray, it can be found that the organization is disordered, there is no texture, and the very dense tumor bone shadow overlaps the loose and damaged bone.