Table 19BONE CANCER AND SARCOMA: investigations

AuthorSettingDescriptionNo.InclusionExclusionResultsGold StdQuality
American College of Radiology, 1999Evidence review presented appropriateness criteria for imaging techniques for evaluating bone tumours. A routine X-ray was given the highest rating of appropriateness for investigation of patients with suspected bone lesionsWhen a classically benign-appearing lesion is detected on routine X-ray, additional studies may not be necessary unless surgical intervention is contemplated. When routine X-ray features are indeterminate or the lesion is more aggressive and considered to be potentially malignant, additional imaging studies are frequently required. MRI has been demonstrated to be superior to CT for staging bone tumours before treatment.
Widhe and Widhe, 2000102 patients with osteosarcoma and 47 patients with Ewing’s sarcoma.Patients aged up to 30 years old were identified from the Swedish cancer registry and records were obtained for those with osteosarcoma and with Ewing’s sarcoma.68 (67%) of patients with osteosarcoma and 28 (60%) of those with Ewing sarcoma had a radiograph organised at the first medical visit. However, the correct diagnosis was not established for all patients who had a radiograph. The radiograph was misinterpreted by the radiologist as normal or inconclusive for six (9%) of those with osteosarcoma and 12 (43%) of those with Ewing’s sarcoma. When a radiograph was ordered at the first visit, the doctor’s delay to diagnosis averaged eight weeks, compared to 19 weeks when a radiograph was not ordered (p <0.0001).

From: Appendix B, Evidence Tables

Cover of Referral Guidelines for Suspected Cancer in Adults and Children
Referral Guidelines for Suspected Cancer in Adults and Children [Internet].
NICE Clinical Guidelines, No. 27.
Clinical Governance Research and Development Unit (CGRDU), Department of Health Sciences, University of Leicester.
Copyright © 2005, National Collaborating Centre for Primary Care.

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