title: Plain radiologic findings and chronological changes of incipient phase osteosarcoma overlooked by primary physicians.
abstract: BACKGROUND
  We assessed the plain radiographic characteristics of 10 cases of osteosarcomas during the initial painful period that had been overlooked by a primary physician. In addition, we evaluated chronologic changes in radiographic findings from initial symptomatic period to the time of accurate diagnosis.
  
  
  METHODS
  The clinical records were reviewed for clinical parameters including age, sex, location, presenting symptoms, initial diagnosis, duration from initial symptoms to definite diagnosis, and initial and follow-up plain radiographic findings of the lesion.
  
  
  RESULTS
  Initial clinical diagnoses included a sprain in 6, growing pain in 2, stress fracture in 1, and infection in 1 patient. Initial plain radiographic findings were trabecular destruction (100%), cortical disruption (60%), periosteal reaction (60%), and soft tissue mass (10%). Intramedullary matrix changes were osteosclerosis in 6 and osteolysis in 4 patients. On progression, 4 cases with minimal sclerosis changed to osteoblastic lesion in 3 patients and osteolytic lesion in 1. Four cases with faint osteolytic foci transformed into osteolytic lesion in 3 and mixed pattern in 1.
  
  
  CONCLUSIONS
  Notable plain radiologic findings of incipient-stage osteosarcoma include trabecular disruption along with faint osteosclerosis or osteolysis. In symptomatic patients with trabecular destruction, additional imaging study including magnetic resonance imaging should be performed to exclude osteosarcoma in the incipient phase, even without radiologic findings suggesting malignant tumor, such as cortical destruction or periosteal reaction.
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Song
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Dae-Geun
authors.initials: DG
authors.lastname: Jeon
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Wan Hyeong
authors.initials: WH
authors.lastname: Cho
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Chang-Bae
authors.initials: CB
authors.lastname: Kong
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Jung Wook
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Soo-Yong
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001859:Bone Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012516:Osteosarcoma / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult
keywords: Chronological changes; Incipient phase; Osteosarcoma; Plain radiographic findings