The diagnostic values of the presence of Virchow's node (VN) or rectal shelf (RS) in spinal metastasis from adeno-carcinoma of unknown origin were studied prospectively in 60 patients during 1986–1988. These were compared with 14 cases with other malignancies of the spine and 37 controls with nonneoplastic spinal lesions. The diagnosis was confirmed by histologic study in all malignant cases. The results were analyzed by diagnostic test analysis and McNemar X, testing. This yields 18.3–21.6%, 97.2–100%, and 92.8–100% sensitivity, specificity, and predictive value, respectively, for a positive test for VN and RS to differentiate significantly adenocarcinoma from other malignancies and control patients (P< 0.005). These findings may thus be considered as a simple and economic guide for physicians to determine the proper approach to patients with a spinal lesion suspected to be malignant.