Asymptomatic children had a 18.9% prevalence of benign bone tumors
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A historical asymptomatic population revealed a 18.9% prevalence of benign childhood bone tumors of the extremities, according to results.
Christopher D. Collier, MD, and colleagues reviewed a historical, longitudinal radiographic collection of healthy children that included comprehensive, left-sided radiographs of the extremities at yearly intervals. A multidisciplinary panel reviewed all potential tumors and confirmed the radiographic diagnosis of each lesion, the age at which the lesion first appeared and the age at which it had resolved. Researchers calculated prevalence rates using the number of distinct patients available for each radiographic location and age.
Of the 262 patients with 25,555 radiographs screened for benign bone tumors at a median age of 8 years, researchers identified 35 tumors in 33 patients, including 19 non-ossifying fibromas, eight enostoses, six osteochondromas and two enchondromas. Results showed a prevalence rate of 18.9% for all tumors combined, which increased with age.
For specific tumor types, researchers noted a prevalence rate of 7.5% for non-ossifying fibromas, 5.2% for enostoses, 4.5% for osteochondromas and 1.8% for enchondromas. Researchers found a bimodal distribution of prevalence among non-ossifying fibromas, with a peak at 5 years at 10.8% and another after skeletal maturity at 13.3%. Results showed a median age of 9 years for the first appearance for all tumors combined. However, age at first appearance varied by tumor type, according to researchers.
Researchers found non-ossifying fibroma often resolved, with further resolution possible beyond the last available radiograph, while enostoses, osteochondromas and enchondromas persisted until the last available radiographs in all patients.
“Despite the inherent limitations of our historical study, it may provide the best available evidence regarding the natural history of asymptomatic benign childhood bone tumors,” Collier told Healio Orthopedics. “This information can be used to counsel patients by providing reassurance and addressing many questions frequently encountered by orthopedic surgeons.”
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Between the Hamann-Todd Human Osteological Collection and the Bolton-Brush radiographic collection, Cleveland offers a unique intersection of orthopedics and forensic pathology. In this study, Christopher D. Collier, MD, and colleagues pored more than 25,555 radiographs of 262 asymptomatic pediatric subjects to arrive at an estimated prevalence for benign bone tumors. They took great efforts to honor the children who were part of what would now be an unethical study, to identify all lesions and apply sound estimating methods so that we can offer better data as we discuss a diagnosis of a benign bone lesion with nervous patients and families in our clinics.
Keeping in mind that this population was mostly white, and that children with “physical and mental defects” were excluded, this is the most scientific and high-quality information we have on the topic. One wonders if artificial intelligence technology was applied to screen the entire radiographic library from more than 4,400 subjects, if the results would be any different. With the diligence of the authors to screen this sample and account for their limitations, I think probably not.
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