Benign Bone Lesions: Do They Warrant Follow-Up?
Authors: Brook Andrew , Volaski Harrison , Kleinbart Emily , Wang Jichuan , Singh Swapnil , Yang Rui , Hoang Bang , Al-Hardan Waleed , Zhang Ranxin , Thornhill Beverly , Geller David S. 
Published: June 2023

Background

There are no established surveillance guidelines for benign bone lesions, particularly for those that do not merit surgery. It is unclear how long or how often patients should be followed, what type of radiographic studies should be obtained, and how frequency repeat imaging should be performed. Given that follow-up incurs cost, time, and resources, it is essential to better understand the probability of lesion progression and the necessity, or lack thereof, for clinical and radiographic observation.

Methods

A retrospective review was conducted between 2015 and 2020 of patients of all ages, races, and sexes diagnosed with a benign bone lesion after radiographic imaging.

Patients diagnosed with benign bone lesions outside of the study period or not managed by an orthopedic surgeon were excluded. Outcomes included presenting symptoms, the date of visits to an orthopedic surgeon, imaging, the appearance or type of lesion, and lesion location. Patients were divided into two groups, those who were observed (Group 1) and those who underwent surgery during the duration of the study (Group 2). Both groups were subdivided into patients who were asymptomatic (Group 1a and Group 2a) or symptomatic at presentation (Group 1b and Group 2b). Descriptive statistics were used to analyze the data extracted.

Results

Of the 638 patients included, 10 patients (1.6%) demonstrated a change in either lesion size or morphology, 9 of which were pediatric patients. Patients in Group 1a were followed, on average, for 207.0 days and returned to the office 1.3 times after their initial visit. Patients in Group 1b were followed, on average, for 130.0 days and returned to the office 1.4 times after their initial visit. Patients in Group 2a were followed, on average, for 191.8 days and returned to the office 1.4 times after their initial visit. Patients in Group 2b were followed, on average, for 102.0 days and returned to the office 1.2 times after their initial visit. The most common imaging study obtained were plain radiographs. Patients in Group 1a received repeat imaging studies, on average, every 100.7 days while patients in Group 1b received repeat imaging studies, on average, every 69.3 days. Patients in Group 2a received repeat imaging studies, on average, every 90.3 days while patients in Group 2b received repeat imaging studies, on average, every 47.3 days.

Conclusions

Benign bone lesions are common incidental findings, and most require no surgical intervention. There are currently no guidelines for how long and how frequently patients should be followed, either clinically or radiographically. This study demonstrates that progression is an extremely uncommon event. Moreover, when progression does occur, it is often accompanied by clinical symptomatology. Limiting clinical and radiologic follow-up to symptomatic individuals would save most patients from incurring costs related to unnecessary clinical visits and repeat imaging studies and reduce their overall lifetime exposure to radiation. In an increasingly resource-challenged environment, routine sequential follow-up may be hard to justify. Reassuring patients and parents that access is available, if and when needed, may be helpful in managing concern while limiting cost and exposure.