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

Context: Accurate diagnosis and timely treatment of pediatric bone lesions are essential, as delayed or incorrect diagnosis canresult in significant morbidity. Bone infections such as osteomyelitis and primary bone sarcomas - including osteosarcoma andEwing's sarcoma - often present with similar clinical and radiological features, creating substantial diagnostic challenges. Thisnarrative review synthesizes current evidence on the clinical presentation, diagnostic complexities, and multidisciplinarymanagement strategies for differentiating between bone infections and sarcomas in pediatric patients. By offering practicalguidance for healthcare providers, this review aims to enhance diagnostic accuracy, reduce the risk of misdiagnosis, andimprove overall patient outcomes. Evidence Acquisition: A comprehensive literature review was conducted, focusing on the clinical features, diagnosticimaging, and biomarkers used to differentiate bone infections from sarcomas. The review also examines the role ofmultidisciplinary 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 differentialdiagnosis challenging. Diagnostic imaging modalities, including plain radiography, magnetic resonance imaging (MRI), andcomputed tomography (CT), are essential but mayyield inconclusive results. Advanced diagnostic tools - such asimmunohistochemistry, molecular genetics, and liquid biopsy - have demonstrated potential in enhancing diagnosticprecision. A multidisciplinary team approach, involving sarcoma surgeons, pathologists, oncologists, and radiologists, isessential for comprehensive assessment and individualized treatment planning, ultimately contributing to improved patientoutcomes. Results and Conclusions: Differentiating between bone infections and sarcomas in pediatric patients remains a significantclinical challenge due to their overlapping symptoms and radiological features. Early and accurate diagnosis, combined with acoordinated multidisciplinary treatment approach, is crucial for achieving optimal patient outcomes. Future research shouldfocus on refining diagnostic pathways, developing novel and disease-specific biomarkers, and strengthening multidisciplinarycollaboration to further enhance the precision of diagnosis and the effectiveness of treatment for pediatric bone lesions