Review Question - QID 3625

The radiographs show a cortically based lytic lesion in the mid diaphysis of the left femur, which is consistent with a metastatic lesion from a lung carcinoma, however without a history of biopsy proven bone metastasis, this lesion needs to be biopsied prior to definitive treatment. Sending femoral reamings is not an appropriate biopsy technique as significant contamination of the abductors, skin, and femoral canal occurs which compromises limb salvage if this lesion is in fact a sarcoma. The biopsy may be followed by intramedullary stabilization under the same operation if the lesion can be confirmed as a carcinoma by the surgical pathologist in a timely manner while the patient remains under anesthesia. However if carcinoma cannot be confirmed, no further treatment is indicated until final pathology is available for review.

In both her JAAOS and ICL reviews, Weber et al discuss the evaluation, biopsy, and treatment of patients who present with destructive bone lesions, presumed to be related to metastatic disease. Her recommendations include biopsy of all destructive bone lesions without a history of known bone metastatic disease.

Rougraff reviews the workup of patients with carcinoma metastatic to bone. While making this diagnosis is a simple matter of obtaining tissue for the surgical pathologist, the correct diagnosis can be difficult, especially in GI lesions which may or may not appear on systemic staging studies. As such, systemic staging, bone scan, lab work, and physical examination become crucial to the diagnosis of metastatic carcinoma.