Role of Novel ACR Bone-reporting and Data System in Risk Stratification of Bone Tumours in South Indian Population: A Retrospective Observational Study

Introduction: The American College of Radiology (ACR) Bone-Reporting and Data System (Bone-RADS) gave a structured framework for assessing and reporting bone tumours. Aim: To evaluate the diagnostic performance of the ACR Bone-RADS score on radiographs in assessing bone tumour risk, with a specific focus on associating radiological findings with histopathological outcomes. Materials and Methods: A retrospective observational study was conducted on 51 patients who underwent radiographic examination for suspected bone tumours between January 2024 and January 2025 at Apollo Institute of Medical Sciences and Research, Hyderabad, India. Bone tumours were categorised as benign, intermediate or malignant based on a reference standard of histology or clinical–radiological consensus by a senior radiologist. Five radiographic characteristics (margin, periosteal reaction, endosteal erosion, pathologic fracture, and extra-osseous mass) were assessed by two radiologists, who calculated a cumulative score (points from radiographic features and cancer history) and assigned a Bone-RADS category to each radiograph. The diagnostic performance of Bone-RADS and inter-reader concordance were assessed using univariate logistic regression analyses and Chi-square analysis. Results: In the current study, the mean age of the study population was 26.06±13.625 years, and the majority of participants were males. The Bone-RADS score demonstrated good diagnostic performance with an AUC of 0.718 (CI: 0.572, 0.863; p<0.001) and high sensitivity (85.19%) and low specificity (58.33%). Statistically significant radiographic predictors of malignancy in the current study are tumour margination, periosteal reaction, and extraosseous soft-tissue. Excellent interobserver reliability (ICC=0.95) was noted for Bone-RADS point total/category. Conclusion: The current study findings suggest that the implementation of ACR Bone-RADS in clinical practice enhances diagnostic precision, facilitates communication among healthcare providers, and improves patient management outcomes.