Lodwick classification

The Lodwick classification is a system for describing the margins of a lucent/lytic bone lesion. The terms used in the description suggest the level of concern for an aggressive, and possibly malignant, process.

  • type 1: geographic
    • 1A: thin, sclerotic margin
    • 1B: distinct, well-marginated border, but not sclerotic 
    • 1C: indistinct border
  • type 2: moth-eaten
  • type 3: permeative

The classification scheme is vaguely ordinal, with higher numbers representing more aggressive disease, but the terminology should be used more as a way to suggest a range of differential diagnoses than as an indication of malignancy (for instance, benign osteomyelitis could have a type 3 appearance).

Type 1A is usually indicative of a benign lesion with slow growth kinetics (e.g. unicameral bone cyst). Treated metastases may also show a sclerotic rim, however.

The differential for type 1B lesions contains malignant lesions.

Differentiation between types 2 and 3 may be difficult, but often the distinction is not essential, and further imaging (CT or MRI) should be pursued.

Mixed types are possible in some scenarios (for instance transformation of a benign lesion into a malignant lesion).

In addition to the Lodwick classification, periosteal reaction may help characterize a bone lesion.

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rID: 33206
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Cases and figures

  • Figure 1: revised Lodwick classification
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