Role of chest imaging in GCTB staging and surveillance

Giant cell tumour of bone (GCTB) is a locally aggressive benign tumour. It rarely metastasises to the lungs. We aim to analyse the risk factors associated with the development of pulmonary metastasis from GCTB.

We retrospectively studied 486 patients with GCTB from August 2007 to July 2024 at a single tertiary MSK oncology centre. Possible risk factors for pulmonary metastasis, including age, pathological fracture, pregnancy, recurrence and anatomical site, were analysed using univariate logistic regression methods. Pulmonary metastasis-free survival was also analysed for the patients using Kaplan-Meier survival analysis.

Two hundred fifty-seven patients had chest imaging with either radiographs (n = 108) or CT scans (n = 162). The median age was 36 (8-89) years. The median follow-up was 64 (3-202) months. Six patients (2.2%) developed pulmonary metastasis; one had metastasis at diagnosis. Seven patients (2.7%) had indeterminate pulmonary nodules (IPNs). Using univariate analysis, local recurrence was the only statistically significant risk factor for pulmonary metastasis (p < 0.03). All of the patients with pulmonary metastasis were treated with denosumab, and two of them had surgical excision as well. No patients have died from pulmonary metastasis.

Pulmonary metastasis in GCTB is rare. Local recurrence is a significant risk factor for pulmonary metastasis. Chest imaging may be indicated only in recurrent GCTB.