Osteosarcoma — Genes & Biomarkers Summary Gene / BiomarkerBad ScoreFree ActionsNon-free Actions TP53GenePathogenic mutationGenetic counseling;family screeningTumor NGS panel RB1GeneBiallelic lossOphthalmic surveillanceArray CGH / WGS RECQL4GeneGermline variantFamily history reviewHereditary gene panel DLG2GeneHemizygous deletionLifestyle surveillanceSNP / CNV array RUNX2GeneOverexpressionClinical risk assessmentIHC tissue profiling ALPBiomarkerElevated (>2× ULN)Standard blood panelBone-specific ALP assay LDHBiomarkerElevated (>ULN)Routine lab workupLDH isoenzyme assay VEGFBiomarkerHigh expressionClinical observationSerum VEGF assay