Version July 2025
| At presentation and prior to local control | |
| Site | Testing |
| Primary and bone metastases | AP and lateral radiographs |
| Primary tumor | MRI with gadolinium (presurgery exam should be performed within four weeks of local control procedure) |
| Bone metastases | MRI with gadolinium or CT scan with contrast (recommended for possible bone metastases if diagnosis uncertain) |
| Chest | CT without contrast |
| Whole body | FDG-PET/CT (recommended at presentation, particularly if primary bone tumor negative on bone scintigraphy) |
| Baseline after local treatment | |
| Site | Testing and timing |
| Primary and bone metastases | AP and lateral radiographs within two weeks of surgery |
| Primary tumor | MRI with gadolinium or CT scan with IV contrast (in patients without significant metallic artifact at primary tumor site) three to four months after local control |
| Bone metastases | MRI with gadolinium or CT scan with contrast (recommended for possible bone metastases if diagnosis uncertain) |
| Surveillance on chemotherapy | |
| Site | Testing and timing |
| Primary and bone metastases | AP and lateral radiographs after 10 cycles (approximately halfway through postoperative chemotherapy) MRI with gadolinium or CT scan with IV contrast recommended if symptoms or abnormal imaging (and surgical intervention or radiation therapy contemplated) |
| Chest | CT without contrast after 10 cycles (approximately halfway through postoperative chemotherapy) |
| Whole body | FDG-PET/CT (if disease positive on prior FDG-PET/CT and bone scan-negative) recommended or PET/MRI
|
| Surveillance postchemotherapy | |
| Site | Testing and timing |
| Primary and bone metastases | AP and lateral radiographs every three months × 8, then every six months × 6, then every 12 months × 5 MRI with gadolinium or CT scan with IV contrast recommended if symptoms or abnormal imaging (and surgical or other intervention contemplated) |
| Chest | CT without contrast every three months × 8, then every six months × 6, then every 12 months × 5 |
| Whole body | FDG-PET/CT (if positive on prior scans and bone scan-negative) if symptoms or abnormal imaging and surgical or other intervention contemplated |
