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Osteogenic Sarcoma





Laboratory Investigations:

Complete Blood Count (CBC)

Usually normal


Usually normal

Alkaline Phosphatase


50% have elevated ALP, may be related to prognosis


Elevated in osteomyelitis

Calcium and Phosphate

Usually normal



Local imaging should be completed prior to any biopsy as the edema from the biopsy can make the images uninterpretable.

Systemic imaging can be withheld until after the biopsy confirms the diagnosis, but if there is a high index of suspicion then it can facilitate care to get the investigations booked in advance.

Local Imaging

Plain X-rays

  • Gold standard for diagnosis


CT scan

  • Does not usually add anything over X-ray in limb OS
  • Useful in pelvis, head and neck


MR scan

  • Shows extent of soft tissue mass
  • Usually non-specific findings
  • Essential for surgical planning


Systemic Imaging

Chest X-ray

  • Easily available
  • Detects metastases >5-10mm
  • Often used for post-treatment monitoring


Chest CT

  • More sensitive than Chest X-ray, but higher radiation dose
  • May have false-positives with small nodules
  • All patients should have a baseline Chest CT


Bone Scan

  • Detects bone metastases
  • NOT useful for deciding if a lesion is malignant or not



  • Still unproven, but increasingly used.
  • More sensitive for soft tissue masses than a bone scan
  • May have a role in assessing treatment response




Investigations to assess baseline function prior to chemotherapy:

Creatinine clearance

Cisplatinum likely to affect renal function


Adriamycin associated with risk of cardiomyopathy


Cisplatinum associated with high frequency sensory-neural hearing loss



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