Percutaneous CT-guided curettage of osteoid osteoma with histological confirmation: a retrospective study and review of the literature

Abstract

Osteoid osteoma is a benign bone tumour usually occurring in young individuals (10-30 years). It presents with intense pain (typically nocturnal), which can be alleviated by salicylates. Treatment consists of surgical excision or destroying the nidus and it is curative. In the past, surgery was performed in an "open" fashion and the nidus had to be removed with a bone block. This extensive type of surgery could be associated with some rates of both failure and complication. There is growing evidence to suggest that percutaneous CT-guided removal or destruction of the nidus is a good alternative and it is indeed gaining worldwide popularity. We present a series of 18 consecutive patients with osteoid osteoma of the pelvis, femur, and tibia, treated percutaneously under CT guidance. Removal of the nidus was performed using a 4.5-mm cannulated drill and a cannulated curette of our own design. Tissue samples for histological evaluation were obtained in the same way. The mean follow-up time was 29 months. Sixteen patients were initially cured. The procedure had to be repeated in two patients and was eventually successful (primary and secondary success rates 88 and 100% respectively). The diagnosis was histologically confirmed in 14 cases out of 18 (77%). In four cases no histological confirmation of osteoid osteoma could be achieved. There were only two minor complications, one case of femoral neuropraxia and one case of skin abrasion. Percutaneous CT-guided removal seems to be efficient and safe for the treatment of osteoid osteoma. The use of a cannulated drill and a cannulated curette facilitates efficient removal of the tumour and procurement of tissue for diagnosis.

Follow-up of thirty-three computed-tomography-guided percutaneous radiofrequency thermoablations of osteoid osteoma

“…Fenichel et al [9] reported a 77% success rate at confirming the histology when using a cannulated currete.…”

“…These fragments were obtained during the drilling process using a standard machine-driven drill compared to our method of using a hand-driven core drill with a 5-mm diameter. Other studies even describe the true positive rate to be as low as 36% [2][3][4][5][6][7][8][9].…”

“…Moreover, the removal of large portions of cortical bone weakens the affected long bone considerably and for long periods of time. In view of these disadvantages, the trend is now changing worldwide toward minimally invasive procedures to reduce failure rates and avoid potential complications [9].…”

“…Incomplete removal usually results in a clinical recurrence [9]. Attempts to overcome this problem have led to the development of numerous methods to improve intraoperative localisation of the nidus [9][10][11][12][13][14]. Moreover, the removal of large portions of cortical bone weakens the affected long bone considerably and for long periods of time.…”

“…The main difficulty with this technique is in the intraoperative identification of the nidus, and misjudgment often results in failure of the procedure due to incomplete resection. Incomplete removal usually results in a clinical recurrence [9]. Attempts to overcome this problem have led to the development of numerous methods to improve intraoperative localisation of the nidus [9][10][11][12][13][14].…”