How to overcome the difficulty in diagnosing osteosarcoma

When osteosarcoma is serious, it will always affect personal safety. Patients must pay great attention to it, because early diagnosis of osteosarcoma is very important for the treatment and prognosis of the disease, and osteosarcoma is a disease with relatively uncommon symptoms after onset. So below I will introduce to you how to overcome the difficulty of diagnosing osteosarcoma? I hope it will be helpful to friends in need.

Osteosarcoma has always been a difficult point in pathological diagnosis and a hot topic of research. The patient's clinical manifestations, imaging changes, and pathological morphological manifestations are currently the main methods for diagnosing osteosarcoma. With the change of new chemotherapy drugs and surgical methods, the survival rate of osteosarcoma patients has improved. Currently, researchers have studied a series of molecular markers, but there is still no specific molecular marker that can improve the diagnosis rate of osteosarcoma and improve the patient's prognosis. The following are relatively effective methods for diagnosing osteosarcoma:

1. Clinical manifestations

The history of osteosarcoma is usually 1 to 3 months. Local pain is an early symptom, which may occur before the appearance of a lump. It is intermittent at first, and gradually turns into continuous severe pain, especially at night. The tumor near the bone end near the joint is large, with varying hardness, tenderness, high local temperature, dilated veins, and sometimes palpable pulsation. There may be pathological fractures.

2. X-ray examination of osteosarcoma

1. Changes in cancellous bone and medullary cavity The most characteristic change of osteosarcoma is bone hyperplasia, among which tumor new bone formation is an important feature, mixed with reactive bone hyperplasia. X-ray shows bone sclerosis and whitening. There are several types of changes in the cancellous bone and medullary cavity of the metaphysis: ① uniform ground-glass density increase; ② foggy, patchy or mass-like tumor new bone formation; ③ reactive bone sclerosis; ④ bone destruction

2. Changes in the bone cortex In the early stage, the bone undergoes osteolytic destruction, and the bone density decreases, which is manifested as sieve-like thin translucent lines. Later, the cortical surface becomes uneven, and the bone density increases after the formation of tumor bone in the osteolytic area.

3. Periosteal reaction.

3. CT examination of osteosarcoma

It can accurately display the tumor, which can be manifested as varying degrees of bone destruction on plain scans, or irregular cortical thickening and bone sclerosis. Periosteal hyperplasia is manifested as high density, and tumor invasion of the medullary cavity increases the density of low-density intramedullary tissue and has a tendency to spread. If a skip metastasis is formed, the bone cortex will be interrupted. CT enhanced scanning can clearly show the edge of soft tissue and is helpful in showing the relationship between the tumor and nearby large blood vessels.

Pathological examination

When the clinical and imaging manifestations of the lesion suggest a typical osteosarcoma, a puncture biopsy is often used to confirm the diagnosis. A biopsy must be performed before surgical treatment. Generally speaking, failure to follow the appropriate biopsy procedure may lead to adverse treatment outcomes. The selection of the biopsy site is very important for subsequent limb-salvage surgery. The puncture point must be located at the incision line of the final surgery so that the puncture tract can be removed during the final surgery. Therefore, it is recommended that the biopsy be performed by the final surgeon or his assistant in the hospital where the surgical treatment is planned.

The examination of osteosarcoma must follow the principle of combining clinical, imaging and pathological examinations. Only by obtaining pathological evidence through biopsy can the diagnosis be confirmed. So far, no highly specific tumor markers that can be used for early diagnosis have been found. However, new imaging examination methods have greatly improved the accuracy of osteosarcoma diagnosis. X-rays can make a qualitative diagnosis of most osteosarcomas. The rational use of these examination methods can increase the chance of early diagnosis and facilitate accurate surgical staging to guide treatment.