Use of Imaging Prior to Referral to a Musculoskeletal Oncologist

Benjamin J. Miller, MD, MS


J Am Acad Orthop Surg. 2019;27(22):e1001-e1008. 

In This Article

Abstract and Introduction


The Musculoskeletal Tumor Society and American Academy of Orthopaedic Surgeons recently collaborated on a clinical practice guideline Use of Imaging Prior to Referral to an Orthopaedic Oncologist. The complete manuscript is available on OrthoGuidelines ( and the Musculoskeletal Tumor Society website ( This clinical practice guideline is designed to assist practitioners without specialization in musculoskeletal tumors to determine the most efficacious imaging modalities for establishing an accurate diagnosis and treatment plan when confronted with a bone or soft-tissue lesion of unknown etiology. A panel of experts with interest and expertise in orthopaedic surgery, orthopaedic oncology, and musculoskeletal radiology created relevant questions and synthesized existing literature into 12 topics and 27 recommendations. The group considered several common clinical and radiographic features often seen at the initial presentation of a bone or soft-tissue tumor of the pelvis or extremities. This guideline is intended to inform front-line practitioners to give insight into imaging modalities that are of minimal clinical utility, as well as those that are critical to establishing an accurate diagnosis and assessing the urgency of referral to an oncologic specialist. In addition to a summary of the primary findings of the report, we included three cases that illustrate clinical scenarios in which the guidelines can assist in determining the most appropriate first-line management. The strengths of the relevant guidelines are noted.