Plain Radiographs: Unknown Etiology
Moderate evidence supports using conventional radiographs in the initial evaluation of a bone tumor of unknown etiology.

Rationale
One high quality study (Oudenhoven et al) found was a prospective series of 200 hand lesions with histology as the gold standard. Four moderate studies utilized radiographs in a similar way to evaluate bone tumors, and when combined with the high-quality study in meta-analysis, were shown to detect benignity and malignancy with high accuracy as compared to histology (76.5% sensitivity and 86.4% specificity). With respect to the diagnosis of soft tissue tumors of unknown etiology, there is scant published literature regarding the value of conventional radiographs of the tumor site to assist with obtaining a diagnosis or planning further diagnostic studies or treatment. In the absence of reliable evidence, it is the opinion of this work group that certain radiographic findings can be very helpful when present; such as phleboliths in hemangiomas, characteristic ossification patterns of myositis ossificans, mineralization within the substance of the tumor, density of the tumor, and cortical involvement of the underlying bone. However, many times conventional radiographs will not add any additional information regarding the identity of the tumor. Thus, our work group agreed that this test should be regarded as a justifiable, although not universally critical, diagnostic study at initial evaluation of soft tissue tumors.

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