Diagnostic evaluation of patients with metastatic bone disease

Metastatic carcinoma to bone of uncertain primary origin is a common clinical problem that presents to practicing orthopaedic surgeons. The authors present a simple and effective staging system to identify primary malignancies. The role of clinical history, physical examination, laboratory studies, and limited radiographic studies are critical to the success of this diagnostic strategy. Needle or open biopsy frequently is needed yet is usually more effective as a confirmatory study for carcinoma or to rule out primary bone sarcomas. Patients who present with a displaced pathologic fracture require urgent diagnostic and treatment plans that do not compromise future treatment options particularly if the lesion is a primary sarcoma, in which durable skeletal reconstruction is possible.