Lytic bone lesions in an Australian population: the results of 100 consecutive biopsies

The identification of a lytic bone lesion is often perceived as a harbinger of malignancy, especially in an older patient. This study reviews the results of 100 consecutive biopsies of patients who presented with either a solitary lesion or multiple lytic bone lesions in the absence of a history of malignancy.

Following preoperative planning, including plain radiographs, bone scan and computed tomography scanning, an open biopsy was carried out.

The most common site affected was the pelvis (20 patients), followed by the femur (19) and tibia (15). The lesions were solitary in 88 patients and multiple in 12. The most common diagnosis was a secondary carcinoma presenting as a bone lesion, which was found in 25 patients. The carcinomas were a widely distributed group, but the most common among them were renal cell carcinoma (seven patients), breast carcinoma (five patients) and lung carcinoma (five patients). The most common primary bone tumour was a giant cell tumour (16) followed by myeloma (10). Multiple lesions were not universally an indication of a malignant process. In 14 patients the lesion was not a tumour.

This study emphasizes the importance of obtaining a tissue diagnosis.