These recommendations apply primarily to the scenario of pain that cannot be attributed to a competing explanation and is likely due to the underlying lesion. The majority of bone malignancies will cause pain, often described as unassociated with activity and present at rest and night. In the setting of a bone lesion of unknown etiology, the presence of pain suggests an active process that requires further investigation to determine the underlying biology. One moderate quality study (Barai, 2004) found that patients presenting with soft tissue tumors and reporting bone pain at distant sites of metastases reliably correlated to the presence or absence of metastatic sarcoma, which were detected by Tc99 bone scan. Among a population of patients mostly reporting bone pain, two moderate quality studies (Kotb, 2014 and Weger, 2013) found that MRI and radiographs can determine benignity of bone tumors with high accuracy but determined malignancy had a weaker association to the reference standard. Although the advanced imaging modality of choice is an MRI, an exception may be in the case of an obvious bone-forming lesion without a broken periosteal reaction on radiographs that is suggestive of an osteoid osteoma, in which case CT is the preferred imaging modality.
- Barai,S.; Bandopadhayaya,G.P.; Chumber,S.; Gupta,D.K.; Patel,C.D.; Dhanpati,H. Role of skeletal scintigraphy in soft tissue sarcoma: Improving the diagnostic yield
- Kotb,S.Z.; Sultan,A.A.; Elhawary,G.M.; Taman,S.E. Value of diffusion weighted MRI in differentiating benign from malignant bony tumors and tumor like lesions
- Weger,C.; Frings,A.; Friesenbichler,J.; Grimer,R.; Andreou,D.; Machacek,F.; Pfeiffenberger,K.; Liegl-Atzwanger,B.; Tunn,P.U.; Leithner,A. Osteolytic lesions of the calcaneus: results from a multicentre study