investigations
Last reviewed 01/2018
Biochemistry:
- raised ESR and alkaline phosphatase
Radiography - findings variable but look for:
- alternating areas of osteolysis and osteosclerosis
- poorly defined endosteal margin
- breaching of the cortex - with:
- sunray spicules - new bone breaches the cortex and radiates outwards, like a sunburst, into adjacent soft tissue
- Codman's triangle - periosteum lifted into a triangle as the tumour emerges through the cortex
- breaching of the cortex is characteristic but not pathognomonic
- chest radiology may reveal pulmonary metastases - present in about 30 - 40% of patients at first presentation
CT and MRI reliably show the extent of the tumour.
Biopsy is essential to confirm the diagnosis before embarking on treatment.