Clinical and Radiological Concordance of Bone Tumours Using Histopathology as the Gold Standard: A Pilot Study

Bone tumours constitute a heterogeneous group of lesions with overlapping clinical and radiological features, making accurate preoperative diagnosis challenging. Correlating clinical findings and imaging with histopathology may improve diagnostic confidence and guide management. The present study aimed to evaluate the clinical and radiological profile of bone tumours and to determine the degree of clinico-radiological concordance with histopathology, which served as the gold standard.

This hospital-based pilot observational study included 34 patients with suspected bone tumours who underwent clinico-radiological evaluation followed by histopathological confirmation. Demographic and clinical details were obtained from case records. Radiological assessment was based on plain radiography and MRI, with additional CT and PET-CT as indicated. Lesions were assessed for age predilection, anatomical site, bone segment involved, pattern of destruction, margin, cortical breach, periosteal reaction, matrix mineralisation, and soft-tissue extension. A provisional clinico-radiological diagnosis was assigned in each case. Histopathological diagnosis served as the gold standard. Data were analysed using descriptive statistics and diagnostic performance indices.

The mean age at presentation was 24.14 ± 13.17 years, with the highest incidence in the 10-19-year age group (44.1%). Males accounted for 73.5% of cases. Long bones were affected in 88.2% of cases, the most common being the femur (41.2%). Histopathology revealed malignant tumours in 73.5%, benign tumours in 20.6%, and non-neoplastic or inflammatory lesions in 5.9%. The most frequent final diagnosis was osteosarcoma (47.1%), followed by giant cell tumour (17.6%) and Ewing sarcoma (14.7%). Family-level clinico-radiological concordance was 47.1%, rising to 70.6% when the final diagnosis was included among radiological differentials. The sensitivity, specificity, and overall diagnostic accuracy for detecting malignancy were 84.0%, 77.8%, and 82.4%, respectively.

Clinico-radiological evaluation is valuable for preliminary diagnosis, biological stratification, and narrowing the differential diagnosis of bone tumours; however, histopathology remains indispensable for definitive diagnosis and accurate tumour classification.