Tumors of the Spine: When Can Biopsy Be Avoided?

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: None declared. 5. Skeletal Radiol. 2022 Apr;51(4):737-745. doi: 10.1007/s00256-021-03868-8. Epub 2021 Jul 24. The Lodwick classification for grading growth rate of lytic bone tumors: a decision tree approach. Benndorf M(1), Bamberg F(2), Jungmann PM(2). Author information: (1)Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany. matthias.benndorf@uniklinik-freiburg.de. (2)Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany. The estimation of growth rate of lytic bone tumors based on conventional radiography has been extensively studied. While benign tumors exhibit slow growth, malignant tumors are more likely to show fast growth. The most frequently used algorithm for grading of growth rate on conventional radiography was published by Gwilym Lodwick. Based on the evaluation of the four descriptors (1) type of bone destruction (including the subdescriptor "margin" for geographic lesions), (2) penetration of cortex, (3) presence of a sclerotic rim, and (4) expanded shell, an overall growth grade (IA, IB, IC, II, III) can be assigned, with higher grade representing faster tumor growth. In this article, we provide an easy-to-use decision tree of Lodwick's original grading algorithm, suitable for teaching of students and residents. Subtleties of the grading algorithm and potential pitfalls in clinical practice are explained and illustrated. Exemplary conventional radiographs provided for each descriptor in the decision tree may be used as a guide and atlas for assisting in evaluation of individual features in daily clinical practice. © 2021. The Author(s). DOI: 10.1007/s00256-021-03868-8 PMCID: PMC8854272