[The role of projectional radiography in the detection of primary malignant and indeterminate bone neoplasms].

Purpose: To evaluate the role of projectional radiography in the detection of primary and potentially malignant bone neoplasms.
Materials and Methods: We retrospectively reviewed the images and medical records of 80 patients (42 male, 38 female; range: 6 to 73 years; mean: 33 years) with pathologically proven primary or indeterminate bone tumors.
Results: The most common symptom was local pain (84 %). In 69 of 80 patients (86 %), projectional radiography was the first imaging modality, which correctly identified the malignant character of the bone lesion in 60 of these 69 patients (87 %). In 2 patients, bone neoplasms were overlooked due to diagnostically inadequte image quality. The false-diagnosis rate was not significantly different between board-certified radiologists working in hospitals and radiologists in outpatient facilities (p > 0.05). Bone tumors predominantly affecting adults, such as chondrosarcomas, needed a longer time for the diagnosis than bone tumors mainly found in childhood, such as osteosarcomas. The median age of patients with delayed imaging work-up because of attempted conservative therapy (45 years +/- 20 years) was significant higher than the median age of patients with immediate radiographic work-up (27 years +/- 16 years).
Conclusion: Projectional radiography is the most common initial imaging method for bone pain and continues to play an important role to reduce the time gap between first onset of symptoms and definitive treatment. In unremitting focal bone pain, bone neoplasms should be taken into consideration not only in children but also in patients beyond adolescence.