Modified Lodwick-Madewell classification of lytic bone lesions

Last revised by Andrew Murphy on 1 Feb 2021

The modified Lodwick-Madewell classification is a system for describing the radiographic appearance of a lytic bone lesion.

It was proposed in 2016 as a successor to the Lodwick classification and better reflects the risk of malignancy with increasing grade 1.

  • 1A: well-defined, geographic, sclerotic rim
  • 1B: well-defined, geographic, sharp margin, no sclerotic rim
  • 2: geographic, ill-defined margin (partial or circumferential)
  • 3A: change of margin, or progressive endosteal scalloping over time
  • 3B: moth-eaten or permeative
  • 3C: radiographically occult

Grade 1A lesions are typically benign. Many benign lesions have a grade 1B appearance but also metastasis and myeloma may produce this pattern.

Both benign and malignant lesions may appear as grade 2.

Grade 3 lesions suggest aggressive behavior. Grade 3C is found in very aggressive lesions that grow through the bone so fast that there is no time for osteodestruction.

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