Diagnosing Bone Sarcoma

Bone sarcomas form in the tissue that makes up bones. Because there are many types of bone sarcoma, getting an accurate diagnosis is critical to making sure you receive the right care.

At NYU Langone, our goal is to provide you with a diagnosis—or to confirm a diagnosis, if you are looking for a second opinion or have been referred to the Perlmutter Cancer Center by other doctors. Our specialists do so as quickly as possible. You often see the medical director of our bone sarcoma program within two days of your first appointment here, with treatment starting within the week. Treatment needs to start as soon as possible to provide you with the best possible chance of successfully managing the sarcoma. Our sarcoma program director is available during all medical visits, and an attending physician and nurse practitioner are on call every night to answer any questions.

At NYU Langone, your team may include medical, surgical, radiation, and orthopedic oncologists. Reconstructive surgeons, vascular surgeons, and neurosurgeons, as well as physical rehabilitation specialists, may also be part of your care, depending on the complexity of the bone sarcoma.

Our doctors ask about your symptoms and medical history and use the most up-to-date technologies and tests to detect and diagnose the type of bone tumor present.

Blood Tests

Your doctor may use blood tests to measure the levels of certain elements in your body. For example, levels of an enzyme called alkaline phosphatase may be elevated in people with osteosarcoma or chondrosarcoma, whereas people with Ewing sarcoma may have higher levels of an enzyme called lactate dehydrogenase.

X-ray

X-rays use small amounts of radiation to take pictures of the bones, revealing swelling or possible tumors. Bone sarcomas are often recognizable on an X-ray, and your doctor may use this test if tumors are suspected in the arms or legs.

CT Scan

This form of X-ray uses a computer to create three-dimensional pictures, offering doctors various views of the tumor in greater detail than a standard X-ray. CT scans can help your doctor determine whether cancer has spread to other organs, such as the lungs.

MRI Scan

Using a magnetic field and radio waves, MRI creates detailed three-dimensional images of the structures in your body. This test allows your doctor to see the border of a bone tumor and how it might be affecting soft tissue, such as muscles, tendons, and ligaments.

PET Scan

Your doctor may use a PET scan, which can create images of the entire body, if there is a possibility that the cancer has spread. This test requires the injection of radioactive glucose (sugar) into a vein. The glucose tends to collect in the bone sarcoma, allowing it to show up on PET scan images.

Biopsy

A biopsy involves the removal of tissue from bone for extensive molecular and genetic laboratory tests and examination under a microscope for signs of cancer. For example, our doctors may look for changes in the chromosomes—the portions of cells that house genetic material—of bone tumors. They may also study the antigens, or substances that the body recognizes as foreign, in the tissue. Different types of bone sarcoma can produce different types of antigens, and detecting these can aid in the correct diagnosis.

Biopsy results can help your doctor determine what type of bone sarcoma is present and which types of therapies may be most successful.

To obtain a tissue sample, our doctors may use fine needle aspiration, in which a small needle is used to withdraw fluid and cells from the bone tumor. In a core needle biopsy, the doctor uses a larger needle to remove a bigger portion of tissue.

If a bone tumor is difficult to reach, a needle biopsy may be done under the guidance of imaging techniques, such as ultrasound, which uses sound waves to create pictures on a monitor.