The importance of radiographic imaging in the microscopic assessment of bone tumors

Introduction: Primary bone tumors are rare and require a multidisciplinary approach. Diagnosis involvesprimarily the radiologist and the pathologist. Bone lesions are often heterogeneous and the microscopicdiagnostic component(s) may be in the minority, especially on core needle biopsies. Reactive processes,benign, and malignant tumors may have similar microscopic aspects. For these challenging cases, thecorrelation of microscopic and radiologic information is critical, or diagnostic mistakes may be made withsevere clinical consequences for the patient. The purpose of this article is to explain how pathologistscan best use imaging studies to improve the diagnostic accuracy of bone lesions.Diagnosis: Many bone lesions are microscopically and/or radiographically heterogeneous, especially thosewith both lytic and matrix components. Final diagnosis may require specific microscopic diagnostic fea-tures that may be present in the lesion, but not the biopsy specimen. A review of the imaging helps assessif sampling was adequate. The existence of a pre-existing bone lesion, syndrome (such as Ollier diseaseor multiple hereditary exostosis), or oncologic history may be of crucial importance. Finally, imaginginformation is very useful for the pathologist to perform accurate local and regional staging during grossexamination.Conclusion: Close teamwork between pathologists, radiologists, and clinicians is of utmost importancein the evaluation and management of bone tumors. These lesions can be very difficult to interpretmicroscopically; imaging studies therefore play a crucial role in their accurate diagnosis.