Bone sarcoma metastasize often hematogenously, primarily to the lungs and secondly to the bone. In rare cases, lymphatic spreading occurs.
Metastases in the same marrow space, separate from the primary tumor (skip metastases) can occur.
Most patients with a high-grade malignant tumor have micrometastases without clinical detection at the time of diagnosis. Macroscopic lung metastases are present in 15-20%.