OBJECTIVES: 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. METHODS: 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 4/5 (80%) of these were able to provide a diagnosis. CONCLUSIONS: Intramedullary reaming biopsy had a 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: Level III.
Stevens et al. (2026) studied this question.