Modified Lodwick-Madewell classification of lytic bone lesions
Citation, DOI & article data
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.