Diagnostic Challenges and Multidisciplinary Approaches in Differentiating Pediatric Bone Infections from Sarcomas: A Narrative Review

Abstract

Context: Accurate diagnosis and timely treatment of pediatric bone lesions are essential, as delayed or incorrect diagnosis can result in significant morbidity. Bone infections such as osteomyelitis and primary bone sarcomas — including osteosarcoma and Ewing’s sarcoma — often present with similar clinical and radiological features, creating substantial diagnostic challenges. This narrative review synthesizes current evidence on the clinical presentation, diagnostic complexities, and multidisciplinary management strategies for differentiating between bone infections and sarcomas in pediatric patients. By offering practical guidance for healthcare providers, this review aims to enhance diagnostic accuracy, reduce the risk of misdiagnosis, and improve overall patient outcomes. Evidence Acquisition: A comprehensive literature review was conducted, focusing on the clinical features, diagnostic imaging, and biomarkers used to differentiate bone infections from sarcomas. The review also examines the role of multidisciplinary teams in managing these conditions and emphasizes the importance of early and accurate diagnosis. Pediatric bone infections and sarcomas often present with nonspecific symptoms such as pain and swelling, making differential diagnosis challenging. Diagnostic imaging modalities, including plain radiography, magnetic resonance imaging (MRI), and computed tomography (CT), are essential but may yield inconclusive results. Advanced diagnostic tools — such as immunohistochemistry, molecular genetics, and liquid biopsy — have demonstrated potential in enhancing diagnostic precision. A multidisciplinary team approach, involving sarcoma surgeons, pathologists, oncologists, and radiologists, is essential for comprehensive assessment and individualized treatment planning, ultimately contributing to improved patient outcomes. Results and Conclusions: Differentiating between bone infections and sarcomas in pediatric patients remains a significant clinical challenge due to their overlapping symptoms and radiological features. Early and accurate diagnosis, combined with a coordinated multidisciplinary treatment approach, is crucial for achieving optimal patient outcomes. Future research should focus on refining diagnostic pathways, developing novel and disease-specific biomarkers, and strengthening multidisciplinary collaboration to further enhance the precision of diagnosis and the effectiveness of treatment for pediatric bone lesions.