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 to have had cancer. This was compared with standard clinical radiologic techniques. The skeletons of 128 diagnosed cancer patients from an early 20th century autopsied skeletal collection (Hamann-Todd Collection) were examined. Radiologic examination detected evidence of metastatic disease in 33 individuals, compared to 11 by visual examination of the postcranial skeletons. Four of these cases were detected by both techniques. Blastic lesions were most commonly overlooked on visual examination, because they were localized to trabecular (internal bone) structures. The ilium was the most commonly affected bone, with lytic or blastic lesions detected in 30 of 33 individuals. While the proximal femur was affected in only nine individuals, x-ray of the proximal femur and ilium detected all individuals with postcranial evidence of metastatic disease. Skeletal distribution of metastases provides no clue to the location of origin or histologic subtype of the cancer. Survey of archeological human remains for metastatic cancer requires radiologic examination. Such skeletal surveys should x-ray at least the ilia and femora.