Semin Musculoskelet Radiol 2017; 21(05): 630-647
DOI: 10.1055/s-0037-1606130
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

ESSR Consensus Document for Detection, Characterization, and Referral Pathway for Tumors and Tumorlike Lesions of Bone

Radhesh Lalam1, Johan L. Bloem2, Iris M. Noebauer-Huhmann3, Klaus Wörtler4, Alberto Tagliafico5, Filip Vanhoenacker6, Violeta Vasilevska Nikodinovska7, Hatice Tuba Sanal8, Henk-Jan van der Woude9, Olympia Papakonstantinou10, Gunnar Åström11, Mark Davies12, Amanda Isaac13, Marc-André Weber14
  • 1Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
  • 2Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  • 3Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
  • 4Department of Radiology, Technical University of Munich, Munich, Germany
  • 5University of Genova and AOU IRCCS San Martino IST, Genova, Italy
  • 6Department of Radiology, Universities of Antwerp and Ghent, General Hospital Sint-Maarten, Duffel-Mechelen, Duffel, Belgium
  • 7Department of Radiology, University Surgical Clinic “St. Naum Ohridski,” University “Ss. Cyril and Methodius,” Skopje, Macedonia
  • 8Department of Radiology, Health Sciences University, Gulhane School of Medicine, Ankara, Turkey
  • 9Department of Radiology, Amsterdam and Leiden University Medical Center, Onze Lieve Vrouwe Gasthuis, Leiden, The Netherlands
  • 102nd Department of Radiology, National University of Athens, “Attikon” Hospital, Athens, Greece
  • 11Department of Surgical Sciences–Radiology, Uppsala University, Uppsala, Sweden
  • 12Midlands Musculoskeletal Imaging, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
  • 13Guy's and St. Thomas' Hospitals NHS Foundation Trust, Kings College, London, United Kingdom
  • 14Institute of Diagnostic and Interventional Radiology, University Hospital Rostock, Rostock, Germany
Further Information

Publication History

Publication Date:
12 October 2017 (online)


Benign bone tumors are rare but are more common than primary malignant bone tumors. The early accurate diagnosis and reliable differentiation of these rare benign tumors and tumor mimickers from the even rarer malignant tumors with subsequent appropriate treatment or watchful waiting is crucial for the clinical outcome. Bone tumors are often a source of diagnostic and therapeutic uncertainty. Thus this European Society of Musculoskeletal Radiology consensus document is intended to help radiologists in their decision making and support discussion among clinicians who deal with patients with suspected or proven bone tumors. Evaluating these tumors starts with a patient history and physical examination. Radiography is the principal imaging modality and often can reliably diagnose a benign bone tumor by providing information about localization, matrix, aggressiveness, size, and (potential) multiplicity. In a significant number of cases, additional imaging is not necessary. Potentially malignant entities recognized by radiography should be referred for magnetic resonance imaging, which also serves as a preoperative local staging modality, with specific technical requirements. Indeterminate tumors, or tumors in which therapy depends on histology results, should be biopsied. For biopsy, we strongly recommend referral to a specialist regional sarcoma treatment center (RSTC), where a multidisciplinary tumor team, including a specialist pathologist, radiologist, and sarcoma surgeon, are involved. Additional staging modalities are entity specific and should be performed according to the recommendations of the RSTC.


This article was approved by the ESSR MSK Tumor Subcommittee. It was submitted as a consensus article to the Seminars in Musculoskeletal Radiology.