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In the early days of Ewing sarcoma staging work-ups for chemotherapy planning and risk stratification in clinical trials, bone involvement with the primary tumor and/or metastases was assessed with (a) 99mTc-MDP bone scan which detect metastatic bone lesions that cause remodeling, and (b) bone marrow aspiration and biopsy. Currently there are many non-invasive methods to assess bone and/or marrow involvement including 99mTc-MDP bone scan 18FDG-PET-CT, and MRI 1. The study by Newman et al. demonstrated that 0/57 patients without osseous metastases on 18FDG PET-CT had bone marrow involvement 1.

Futility versus utility of marrow assessment in initial Ewing sarcoma staging workup