COMPARISON OF RADIOLOGIC AND GROSS EXAMINATION FOR DETECTION OF CANCER IN DEFLESHED SKELETONS

The reliability of visual examination of defleshed bones was assessed for detection of postcranial metastatic disease in individuals known t o have had cancer. This was compared with standard clinical radiologic techniques. The skeletons of 128 diagnosed cancer patients from an ea rly 20th century autopsied skeletal collection (Hamann-Todd Collection ) were examined. Radiologic examination detected evidence of metastati c disease in 33 individuals, compared to 11 by visual examination of t he postcranial skeletons. Four of these cases were detected by both te chniques. Elastic lesions were most commonly overlooked on visual exam ination, because they were localized to trabecular (internal bone) str uctures. The ilium was the most commonly affected bone, with lyric or blastic lesions detected in 30 of 33 individuals. While the proximal f emur was affected in only nine individuals, x-ray of the proximal femu r and ilium detected all individuals with postcranial evidence of meta static disease. Skeletal distribution of metastases provides no clue t o the location of origin or histologic subtype of the cancer. Survey o f archeological human remains for metastatic cancer requires radiologi c examination. Such skeletal surveys should x-ray at least the ilia an d femora. (C) 1995 Wiley-Liss, Inc.