JOT - 2026-09-01 - Journal Article
Intramedullary Reaming Biopsy in Diagnosing Metastatic Long Bone Disease.
Stevens KN, Pan X, Smith KL, Blackburn CW, Jonard BW, Napora JK
Topics
Key Takeaway
Intramedullary reaming biopsy achieved only 70% sensitivity for diagnosing metastatic disease in cancer patients undergoing IMN fixation of long bone lesions, leaving 30% without a tissue diagnosis.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study evaluated the diagnostic accuracy of intramedullary reaming biopsy in cancer patients with known malignancy undergoing IMN fixation of femoral (91%), humeral (7%), or tibial (2%) lesions at a single Level I center from 2013–2021. Of 46 reaming specimens, 32 (70%) established a diagnosis of metastatic disease; 11% of samples were crushed or necrotic on histopathology, though 80% of those still yielded a diagnosis. The 30% diagnostic failure rate calls into question reliance on reaming biopsy alone when tissue diagnosis is required.
Key Limitation
The cohort is 91% femoral lesions from a single institution with only 44 patients, severely limiting generalizability to humeral and tibial lesions and to centers with different reaming or specimen-handling protocols.
Original Abstract
OBJECTIVES
The aim of this study was to describe the diagnostic accuracy of intramedullary reaming biopsy in cancer patients with long bone lesions or suspected pathologic fractures in determining the presence of metastatic disease.
DESIGN
A retrospective review of electronic medical records.
SETTING
Single academic Level I Trauma Center.
PATIENT SELECTION CRITERIA
Patients with a known cancer diagnosis who underwent intramedullary nail fixation for a long bone lesion or pathologic fracture of the femur, humerus, and tibia for whom intramedullary reamings were sent to pathology between January 2013 and October 2021 were included. Patients for whom open biopsy was performed were excluded.
OUTCOME MEASURES AND COMPARISONS
The primary study measure was intramedullary reaming biopsy sensitivity.
RESULTS
Forty-six reamings from 44 patients were included, with a mean patient age of 69 years (range, 41-85 years) and 35 being female (76%). Approximately half of cases were therapeutic fixation of a pathologic fracture (52%) versus prophylactic (48%) in nature. Most reaming biopsies were from the femur (42/46, 91%), followed by humerus (3/46, 7%), and tibia (1/46, 2%). The most common diagnoses were breast (34%) and lung (20%) carcinoma and multiple myeloma (20%). Thirty-two reamings (70%) were able to establish a diagnosis of metastatic disease. Five samples (11%) were crushed or necrotic based on histopathology reports, and 4 of 5 (80%) of these were able to provide a diagnosis.
CONCLUSIONS
Intramedullary reaming biopsy had 70% sensitivity for diagnosing metastatic disease in cancer patients with long bone lesions or suspected pathologic fractures. Intramedullary reaming biopsy is not a useful diagnostic tool in 30% of these patients, and a formal open biopsy with frozen section should be considered for all patients with osseous lesions or suspected pathologic fractures.
LEVEL OF EVIDENCE
Diagnostic, Level IV. See Instructions for Authors for a complete description of levels of evidence.