The reason most patients first come to the bone tumor clinic is pain or a lump. Once the presence of the tumor is established, the first thing that both the physician and the patient need to determine is the nature of the tumor, is it benign or is it malignant? Because of the subsequent treatment options, functional recovery and life expectancy, benign bone tumors are very different from malignant bone tumors. Although the accurate diagnosis of bone tumor requires a combination of patient’s pathogenesis, physical examination, imaging data and biopsy report, in the early stage when these data are not fully available, we can make a prognosis of whether it is a bone tumor, and the benign or malignant nature of bone and soft tissue tumors based on some general patterns. The significance of prediction is to prevent doctors from missing malignant tumors; for patients, it is to avoid mistaking malignant tumors as benign lesions and delaying timely treatment. We have encountered several patients in our clinic who, because of “not caring about the sprain”, “not caring about the vague pain”, or “having a few months of massage for muscle sprain”, were referred to our hospital by other hospitals and had already The malignant tumor has metastasized far away. Pain Most of the pains of orthopedic patients are aggravated by activities, such as fractures, soft tissue contusions and ligament strains. However, for patients with bone tumor, the pain mainly manifests as progressive aggravation and is more obvious at rest and during sleep at night. Patients with soft tissue tumors seldom show pain, and their complaints are usually painless masses that gradually increase in size. Some bone tumors and soft tissue tumors have some specific sites and specific age groups in human body. Often, the correct diagnosis can be made based on the patient’s X-ray and age. For example, giant cell tumor of bone is found in epiphyseal, mostly in 20-40 years old; Ewing sarcoma is found in diaphysis, mostly in 5-25 years old; fibrous dysplasia and histiocytosis are found in diaphysis, mostly in 5-30 years old; osteosarcoma is found in diaphysis, commonly in 15-25 years old, etc. Plain X-rays are often the first examination for patients with bone tumors after consultation. In the aspect of benign and malignant differentiation, X-ray can provide quite good information. Generally speaking, benign tumor has clear boundary, which shows a circle of reactive bone formation around the tumor, and the tumor signal is more uniform. Malignant tumors often have unclear borders with the host bone due to their strong aggressiveness and rapid growth. Especially when the malignant tumor destroys the bone cortex, it will form a characteristic “Codman’s triangle”, “Onion-skinning”, or Osteosarcoma X-rays usually show a “Codman’s triangle”, “Onion-skinning”, or “sunburst”. Osteosarcoma X-rays generally show aggressive osteogenesis and bone destruction; chondrosarcoma or endophytic chondrosarcoma generally shows high density of ossification in the area of bone destruction; and fibrous anomalous hyperplasia has specific “hairy glass”-like changes. The incidence of tumors has been increasing year by year in recent years due to the increased pressure of work and life in modern society, the deterioration of the natural environment, the irregularity of life and rest, and the increase of aging population. In case of rest pain and lump, the first thing you need to do is to take a simple X-ray and then see a professional bone tumor doctor to avoid delaying the treatment when you are not willing to spend time to make an appointment for CT, MRI or bone scan.