Foundational radiology for surgical pathologists: essential concepts in bone neoplasia

Radiologic-pathologic correlation is essential for diagnostic accuracy, particularly when dealing with primary bone tumors. Basic radiology knowledge is an advantage for the pathologist. While most pathologists understand the value of radiologic correlation, it seems the development of the pathologist's own radiologic skills is less emphasized in pathology residency training than, for instance, most surgical specialties, yet radiology remains a critically important datapoint for the pathologist to integrate. As pathologic diagnoses remain the gold standard for bone and soft tissue tumor classification, it behooves pathologists to leverage the invaluable complementary information that can only be gained from direct radiologic correlation. Moreover, with some practice, we find that integration of the corresponding radiologic features provides a window into the biological timeline / aggressiveness of a particular tumor and therefore increases the pathologist's diagnostic confidence. In addition, other valuable clues come with the identification of matrix mineralization (or lack thereof), zones of transition (narrow or wide) with or without corresponding sclerosis, osseous remodeling, periosteal reaction, and much more. While we certainly encourage close interdepartmental collaboration with our musculoskeletal radiology colleagues, we also stress the value of pathologist direct review of imaging and the development of their own radiology skills which improves diagnostic accuracy and confidence. Finally, while this review provides the reader with a strong foundation in musculoskeletal radiology, we firmly believe the best way to build these invaluable skills is through consistent real-time review of the corresponding imaging and direct correlation with histology.