DETECTION OF METASTATIC CANCERS IN BONE: A COMPARISON OF MACROSCOPIC AND RADIOGRAPHIC METHODS

Forensic anthropological literature describes the detection of cancerous lesions on dry bone that originated in soft tissue, later metastasizing to the bone. However, the use of medical imaging equipment to detect these lesions is rarely considered standard practice. Given the mechanisms of cancer metastasis, it is expected that more cancerous lesions would begin inside the bone, thus visible only with the aid of medical imaging equipment. Potentially individuating cancerous lesions may not be detected when employing macroscopic analysis of dry bone and may be excluded from the biological profile, impeding the identification of unknown remains. The objective of this study is to determine if the presence of cancerous lesions in a sample of contemporary skeletons is greater when assessed using radiographs compared to macroscopic examination of dry bone, allowing for more accurate accounts of potentially individuating lesions in unknown remains. The study sample consisted of 30 individuals with reported cancer from the William M. Bass Donated Skeletal Collection. All elements were examined in isolation for the presence of visible lesions following the criteria for differential diagnosis established in the paleopathology literature (2,3,4). Each element was also radiographed at the University of Tennessee Student Health Center by a trained radiology technician. Dry bone and radiographs were examined in isolation, statistical methods comparing the frequencies of lesion presence with each method and assessing the strength of agreement between the methods. Results show that more individuals displayed lesions radiographically compared to macroscopically (66.67%), with 23% of the sample exhibiting lesions only visible on the radiographs. Of the elements selected, lesions appeared most frequently on the skull, followed by the os coxae. Agreement between the methods ranged from slight to substantial, depending on the element under analysis, with substantial agreement occurring in elements when individuals exhibited no lesions. Given these results, the argument can still be made that radiographing skeletal material is a necessity for detecting the full range of disease presence in a contemporary forensic context.