Version May 2024
| 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 |
| AP and lateral radiographs (recommended at presentation only) | |
| Whole body | Technetium bone scintigraphy and/or FDG-PET (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 after 10 cycles (approximately halfway through postoperative chemotherapy) |
| Whole body | Technetium bone scintigraphy (if disease positive on prior bone scintigraphy) or FDG-PET (if disease positive on prior FDG-PET and bone scan-negative) recommended
|
| Surveillance postchemotherapy | |
| Site | Testing and timing |
| Primary and bone metastases | AP and lateral radiographs every three months x 8, then every six months x 6, then every 12 months x 5 |
| MRI with gadolinium or CT scan with IV contrast recommended if symptoms or abnormal imaging (and surgical or other intervention contemplated) | |
| Chest | AP and lateral radiographs every three months x 8, then every six months x 6, then every 12 months x 5 |
| CT recommended if abnormal radiographs | |
| Whole body | Technetium bone scintigraphy (if positive on prior scans) or FDG-PET (if positive on prior scans and bone scan-negative) if symptoms or abnormal imaging AND surgical or other intervention contemplated |
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