The Lodwick classification for grading growth rate of lytic bone tumors: a decision tree approach

Abstract

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.

Tumor-mimicking musculoskeletal infectious lesions: Experience of a single referral center

“…Geographic bone destruction is characterized by a narrow zone of transition of the lesion, which is easily separated from the surrounding normal bone. A sclerotic margin of variable thickness encompasses the lesion in type A [18,19]. Geographic bone destruction usually occurs in benign or benign aggressive bone tumors and osteomyelitis, as in our patient with subacute osteomyelitis.…”

Chondroblastoma of the femoral head: Curettage without dislocation

“…The Lodwick classi cation system was applied to evaluate the degree of bone destruction. The observed appearance was described as follows: Type I represented a geographic pattern; IA signi ed absent or partial cortical penetration with the presence of a sclerotic rim and an expanded shell measuring less than 1cm; IB denoted absent or partial cortical penetration lacking a sclerotic rim or featuring an expanded shell exceeding 1cm; and IC indicated complete cortical penetration [9] . The Musculoskeletal Tumour Society scoring system (MSTS) [10] was used to evaluate the postoperative functional outcome of pediatric patients based on several criteria, including pain, function, emotional acceptance, supports, walking ability, gait.…”

Zero Echo Time vs. T1‐Weighted MRI for Assessment of Cortical and Medullary Bone Morphology Abnormalities Using CT as the Reference Standard

“…): 1) size (maximum mass diameter in centimeters), 2) lesion number (solitary or multiple), 3) location (central, intracortical, periosteal, or parosteal), 4) sclerotic rim (absent, partial, or total), 5) penetration of cortex (absent, thinning, or total penetration), 6) periosteal reaction (absent, noninvasive, or invasive), 7) expanded shell (absent, ≤1 cm, or >1 cm), 8) destruction pattern (geographic, moth‐eaten, or permeative), and 9) matrix mineralization (absent, chondrogenic, osteogenic, or ground glass). All morphological features included in this study were based on findings in previous studies 2,6,24 …”

“…All morphological features included in this study were based on findings in previous studies. 2,6,24 Statistical Analysis SPSS software (IBM, version 26.0) was used for statistical analyses. Means and standard deviations were calculated for continuous variables.…”