Quick and Easy Osteosarcoma Diagnosis

From a Case on our Specialist Support Space.

Someone posted a radiograph of a suspicious looking bone lesion in our support space a few weeks ago to ask our specialists what they thought. Surgeon Dr Mark Newman said it looked like bad news and definitely needed a workup. Then oncologist Dr Penny Thomas added this bit of wisdom about a sensible next step to get an answer:

• • FNA of bony neoplasias have a 60-80% success rate in getting you a diagnosis.

  • What this looks like for me practically is, while I have the patient sedated for rads, if I see a suspicious lesion, I stick some needles into it. (It’s easier than you think - the affected bone is usually soft as.)

  • Dr Penny’s how to guide:

    • Use imaging to direct where you go. You want to be central in the mass, not peripheral, as there will be a lot of reactive change around these masses.

    • Aim for a big lucent area, which will allow you to go quite deep.

    • Use a 23-gauge needle first. If not having much luck (ie you smear what you get, and there’s nothing exciting to see) try a 22-gauge needle next.

    • Don't apply suction to the syringe initially to avoid excessive blood contamination. If you find that you are not getting a good enough sample, then attempt again by applying suction on the syringe.

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