Modified X-Ray Scoring System for Bone Tumors at Dr. Soetomo General Hospital: A Diagnostic Tool for Differentiating Benign and Malignant Lesions
DOI:
https://doi.org/10.64149/J.Carcinog.24.4s.1-9Keywords:
Bone tumor, scoring system, X-ray, diagnostic accuracy, ROC analysisAbstract
Background: Bone tumors, though rare (5% of global malignancies), pose significant diagnostic challenges in resource-limited settings due to morphological complexity, delayed presentation, and reliance on subjective radiographic interpretation. Existing scoring systems like the Lodwick classification and Radiological Evaluation Score for Bone Tumors (REST) lack specificity for advanced-stage cases prevalent in regions like Indonesia, where delayed diagnoses worsen morbidity. REST has notable limitations, including variabilities between observer interpretations, such as cortical erosion and soft tissue swelling, and low AUC values in specific parameters. This study introduces the Modified X-ray Scoring System (MXSS), a novel diagnostic tool integrating seven radiologic parameters tailored to address these gaps.
Methods: A retrospective cross-sectional analysis of 142 histopathologically confirmed bone tumor cases (2021–2023) was conducted. MXSS evaluated tumor characteristics, mineralization, cortical erosion, margin, transitional zone, periosteal reaction, and soft tissue bulging. Diagnostic performance was assessed via ROC analysis, as well as sensitivity, specificity, and inter-observer reliability.
Results: MXSS achieved an AUC of 0.936 (95% CI: 0.889–0.983). Sensitivity and specificity were 91.9% and 92.5%, respectively, with excellent inter-observer reliability (ICC = 0.992). Key findings include its granular parameterization (e.g., detailed margin and periosteal reaction subcategories), adaptability to late-stage tumors, and applicability in settings lacking MRI/CT.
Conclusion: MXSS is a validated, objective tool for differentiating benign and malignant bone tumors, particularly in resource-limited contexts. Its integration into tele-radiology platforms could revolutionize triage in rural clinics, reducing diagnostic delays and unnecessary interventions.
