Western studies report germline TP53 pathogenic variants in 5%–10% of paediatric osteosarcoma cases. Data from the Indian subcontinent are lacking. We retrospectively analysed 23 children (≤15 years) with osteosarcoma, unselected for personal or family history and treated between January 2020 and July 2025 using next generation sequencing cancer predisposition panels (26-, 84- and 94-gene). No patients had consanguinity or stigmata of syndromic predisposition, and only 17.4% had a family cancer history. Germline TP53 pathogenic/likely pathogenic variants were detected in 13% (n = 3). These findings support consideration of germline TP53 testing in paediatric osteosarcoma in low- and middle-income countries wherever feasible, though cost and access barriers remain.
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