Abstract
Introduction: Sending intramedullary reamings for histology in patients with metastaic bone disease (MBD) is routinely done in many centres. However, whether the results of these reamings help in the diagnosis of MBD remains unclear. Recent studies have shown that on the basis of biopsy of the metastases alone, only 35% of the primary tumours are detected. British Orthopaedic Oncology Society guidelines recommend further investigations and a bone biopsy if the primary disease is unknown.
Aim:The aim of this study was to correlate clinical, radiological and histological findings for patients with metastatic bone disease and assess the diagnostic accuracy of the reamings in MBD.
Method: Demographic details, clinical evaluation, radiological findings and the histology results of the bone biopsy or reamings were reviewed retrospectively for all patients admitted in the year 2003 with suspected MBD.
Results:Records and x-rays were identified of 50 patients admitted in 2003 with suspected primary or MBD of a long bone and pain or pathological fracture. . 56% were male. Average age was 69.2years (range 10–98years).
6 patients had primary bone tumour and were referred to the tumour specialist. Of the remaining patients with suspected MBD all required fixation and in all cases intramedullary reamings were sent for histology. 18 patients had a known primary tumour of which 8 (44%) had no evidence of malignancy on histology. 22 patients had an unknown primary tumour of which 19 (86%) had no evidence of malignancy on histology.
Conclusion: Reamings, are a poor method of diagnosis, even in cases where the primary is known the histology is still less than 50 % accurate in confirming malignancy. Therefore, in patients with MBD the diagnostic accuracy of reamings should be re-evaluated due to the high false negative results.
The abstracts were prepared by Mr Roger Tillman. Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
