{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:54:46Z","timestamp":1790794486818,"version":"4.1.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Bone-RADS (Bone Reporting and Data System) is a consensus guideline by the American College of Radiology to assist in the risk stratification of lytic bone lesions. A score is calculated using 5 radiographic factors and a history of primary malignancy. The purpose of this study was to externally validate the Bone-RADS scoring system.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This retrospective review examined radiographs from January 1, 2021, to December 31, 2021. Radiographs were identified via a keyword search for \u201clucent,\u201d \u201costeolytic,\u201d or \u201clytic\u201d in extremity radiograph reports. All radiographs were initially read by a musculoskeletal radiologist. Radiographs of skeletally immature patients, lesions in a bone other than a long bone, primary soft-tissue masses, and negative\/normal radiographs were excluded. Radiographs were independently scored on the basis of the Bone-RADS system by 4 reviewers. In the absence of a biopsy, a lesion was considered benign if it remained stable for 2 years on radiographs. Scores were correlated with final diagnoses to calculate the rates of malignancy and malignant transformation.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Of 1,108 screened radiographs, 423 were eligible. The mean age of the patients was 62 years and 49% were male. A higher Bone-RADS score was associated with a malignant diagnosis (p < 0.001), with an odds ratio of 9.7 (95% confidence interval [CI], 6.2 to 14.9) per 1-unit increase in the score. A higher margin score (p < 0.001), endosteal erosion (p < 0.001), a pathologic fracture (p < 0.001), and a soft-tissue mass (p = 0.02) were associated with increased risk of malignancy. The mean inter-rater agreement (weighted kappa) was 0.52, the inter-rater mean absolute deviation (MAD) was 0.37, and the intra-rater MAD was 0.27. Sensitivity was 97.1% (CI, 94.4% to 98.5%), specificity was 67.4% (CI, 59.3% to 74.5%), positive predictive value was 85.2% (CI, 80.9% to 88.7%), and negative predictive value was 92.4% (CI, 85.7% to 96.1%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n The Bone-RADS scoring system demonstrated moderate diagnostic performance for malignancy risk stratification of lytic bone lesions, with high sensitivity and reproducible binary classification of possibly benign versus malignant. Although inter-rater agreement for the 4-tier score was only moderate, clinically relevant benign-versus-malignant categorization demonstrated higher inter- and intra-rater agreement. These findings support Bone-RADS as a practical triage framework based on musculoskeletal imaging of lytic bone lesions.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Diagnostic\n Level III<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.26.00278","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:00:37Z","timestamp":1790791237000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Validation of the Bone-RADS (Bone Reporting and Data System) Score for Predicting Risk of Malignancy"],"prefix":"10.2106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9230-341X","authenticated-orcid":false,"given":"Alec","family":"Bigness","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, University of South Florida, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9956-0669","authenticated-orcid":false,"given":"Guston","family":"Zervoudakis","sequence":"additional","affiliation":[{"name":"Sarcoma Department, Moffitt Cancer Center and Research Institute, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3325-9468","authenticated-orcid":false,"given":"Jon","family":"Raso","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of South Florida, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9984-542X","authenticated-orcid":false,"given":"Conrad","family":"Stoy","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of South Florida, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0576-3222","authenticated-orcid":false,"given":"Denise","family":"Kalos","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2006-7784","authenticated-orcid":false,"given":"David","family":"Joyce","sequence":"additional","affiliation":[{"name":"Sarcoma Department, Moffitt Cancer Center and Research Institute, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5344-4316","authenticated-orcid":false,"given":"G. 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