Role of chest imaging in GCTB staging and surveillance.
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BACKGROUND: Giant cell tumour of bone (GCTB) is a locally aggressive benign tumour. It rarely metastasises to the lungs. We aim to analyse the risk factors associated with the development of pulmonary metastasis from GCTB. METHODS: We retrospectively studied 486 patients with GCTB from August 2007 to July 2024 at a single tertiary MSK oncology centre. Possible risk factors for pulmonary metastasis, including age, pathological fracture, pregnancy, recurrence and anatomical site, were analysed using univariate logistic regression methods. Pulmonary metastasis-free survival was also analysed for the patients using Kaplan-Meier survival analysis. RESULTS: Two hundred fifty-seven patients had chest imaging with either radiographs (n = 108) or CT scans (n = 162). The median age was 36 (8-89) years. The median follow-up was 64 (3-202) months. Six patients (2.2%) developed pulmonary metastasis; one had metastasis at diagnosis. Seven patients (2.7%) had indeterminate pulmonary nodules (IPNs). Using univariate analysis, local recurrence was the only statistically significant risk factor for pulmonary metastasis (p < 0.03). All of the patients with pulmonary metastasis were treated with denosumab, and two of them had surgical excision as well. No patients have died from pulmonary metastasis. CONCLUSION: Pulmonary metastasis in GCTB is rare. Local recurrence is a significant risk factor for pulmonary metastasis. Chest imaging may be indicated only in recurrent GCTB.