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Reliability study of radiology interpretation in osteosarcoma


Introduction: Radiography interpretation of osteosarcoma is almost similar with the benign and other malignant bone tumors. The radiologists’ ability to accurately diagnose osteosarcoma will determine the therapy and diagnostic consistency. Currently, there is lack of evidence on radiography interpretation reliability of osteosarcoma performed by radiologists. This study aimed to evaluate the interobserver and intraobserver radiologists’ compatibility to confirm the diagnosis of osteosarcoma and explore the interpretation variability of radiological description.

Methods: This was an interobserver and intraobserver reliability study for osteosarcoma radiograph interpretation. The osteosarcoma radiographs, which have been histopathologically diagnosed, were evaluated retrospectively by two observers and twice by one observer in a different timeline. The components of osteosarcoma identified through the radiographs are bone destruction and its pattern, zone of transition, type of periosteal reaction, type of matrix calcification, skip metastasis, and soft tissue mass. The data analyzed with reliability testing through agreement analysis and Kappa value.

Results: After evaluation of 30 radiographs of osteosarcoma, substantial reliability score for periosteal reaction (Kappa 0.79) to almost perfect for bone destruction, types of bone destruction, transitional zone, types of periosteal reaction, calcification matrix, and presence of soft tissue mass (Kappa 0.84-1) were found. There is a strong level of agreement (96.7%) found for skip metastasis. Intraobserver reliability also showed substantial value for the presence of soft tissue mass (Kappa 0.78) and almost perfect for other characteristics of osteosarcoma (0.84-0.93).

Conclusion: Intraobserver and interobserver reliability of osteosarcoma radiograph interpretation was substantial and almost perfect. 


  1. Klein MJ, Siegal GP. Osteosarcoma: anatomic and histologic variants. Am J Clin Pathol. 2006;125(4):555–581. doi: 10.1309/UC6K-QHLD-9LV2-KENN
  2. Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. World Health Organization, classification of tumours: Pathology and genetics of tumors of soft tissue and bone. Lyon: IARC Press; 2013. p. 468.
  3. Damron TA, Ward WG, Stewart A. Osteosarcoma, chondrosarcoma, and Ewing's sarcoma: National Cancer Data Base report. Clin Orthop Relat Res. 2007;459:40–47. doi: 10.1097/BLO.0b013e318059b8c9
  4. Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer. 2009;115(7):1531–1543. doi: 10.1002/cncr.24121
  5. Rosenberg AE. Robins and cotran pathologic basis of disease. 8th ed. Philadelphia: WB Saunders; 2010. p. 1203–1256.
  6. Yarmish G, Klein MJ, Landa J, Lefkowitz RA, Hwang S. Imaging characteristics of primary osteosarcoma: nonconventional subtypes. RadioGraphics. 2010;30:1653-1672. doi: 10.1148/rg.306105524
  7. Plant J, Cannon S. Diagnostic work up and recognition of primary bone tumours: a review. EFORT Open Rev. 2016;1(6):247–253. doi: 10.1302/2058-5241.1.000035
  8. Colleen M. Costelloe CM, John E. Madewell JE. Radiography in the initial diagnosis of primary bone tumors. American Journal of Roentgenology. 2013;200:3-7. doi: 10.2214/AJR.12.8488
  9. Zwaga T, Bove´e JVG, Kroon HM. Best cases from the AFIP: osteosarcoma of the femur with skip, lymph node, and lung metastases. RadioGraphics. 2008;28:277–283. doi: 10.1148/rg.281075015
  10. Gerber E, Said-Hartley Q, Gamieldien R, Hartley T, Candy S. Accuracy of plain radiographs in diagnosing biopsy-proven malignant bone lesions. S Afr J Rad. 2019;23(1):a1768. doi: 10.4102/sajr.v23i1.1768
  11. Salunke AA, Nandy K, Kamani M, Puj K, Pathak S, Patel K, et al. A proposed ‘‘A to Z RAM (Radiograph Assessment Method)’’ for triage of patients with a suspected bone tumour. Radiography. 2021;27(3):P823-830. doi: 10.1016/j.radi.2021.01.001
  12. Wiratnaya IGE, Susila IWRB, Sindhughosa DA. Tuberculous osteomyelitis mimicking a lytic bone tumor: report of two cases and literature review. Rev bras ortop. 2019;54: 731-735. doi: 10.1016/j.rboe.2017.11.015
  13. de Sá Neto JL, Simão MN, Crema MD, Engel EE, Nogueira-Barbosa MH. Diagnostic performance of magnetic resonance imaging in the assessment of periosteal reactions in bone sarcomas using conventional radiography as the reference. Radiol Bras. 2017;50(3):176-181. doi: 10.1590/0100-3984.2015.0166
  14. Fonseca A, Ryan AL, Gibson P, Hendershot E, Hopyan S, Ranson M, et al. Radiological assessment and outcome of local disease progression after neoadjuvant chemotherapy in children and adolescents with localized osteosarcoma. J. Clin. Med. 2020;9:4070. doi:10.3390/jcm9124070
  15. Kundu ZS. Classification, imaging, biopsy and staging of osteosarcoma. Indian J Orthop. 2014;48(3):238–246. doi: 10.4103/0019-5413.132491

How to Cite

Martadiani, E. D., Asih, M. W., Winarti, N. W., Zulfariska, N., Maria, D., & Asih, K. P. (2021). Reliability study of radiology interpretation in osteosarcoma. Bali Medical Journal, 10(2), 915–921.




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