Radiofrequency Ablation Of Osteoid Osteoma Research Articles

Percutaneous radiofrequency ablation of osteoid osteoma: results from 9 years of experience in a third-level center.

Osteoid osteoma is a benign bone tumor that accounts for roughly 2-3% of primary bone tumors and up to 10-12% of benigns bone neoplasms. It is most commonly seen in young adults, and shows male predominance. Over the last years, minimally invasive thermal ablation techniques such as radiofrequency ablation have gained popularity over classical surgery. In this study we evaluate results and complications of CT guided osteoid osteoma radiofrequency ablation. In this retrospective cohort study all patients that were diagnosed with osteoid osteoma and treated using radiofrequency ablation between January 2014 and December 2022 were included. Pain was assessed using Visual Analog Scale (VAS) pre and post procedure. Technical success was established as positioning of the radiofrequency electrode in the nidus. Primary clinical success was defined as absence of pain after one radiofrequency session. All patients that required a second radiofrequency ablation were included in the overall clinical success group. During the studied period, 61 osteoid osteoma radiofrequency ablations were performed. Fiftyseven of them were included in this study, 32 were men and 25 female. Pre procedure median pain was 9 according to VAS score. Only 23 patients were treated as outpatient, the rest stayed in hospital for 24 hours. Median follow up time was 21,7 months (SD 8,3). Biopsy was performed in 52 patients. Technical success was accomplished in 57 patients (100%). Primary clinical success was 80,7% (46 patients). Those who continued with pain or had recurrence after a symptoms free period (11 patients), were treated with a second radiofrequency ablation, achieving an overall success rate of 94,7%. Only one patient suffered a minor complication (1,7%). CT guided osteoid osteoma radiofrequency ablation is a safe, effective and low complication rate procedure, that can be performed on an outpatient basis. We believe it should be considered as a first line treatment option for osteoid osteoma.

Short- and Long-Term Outcomes after Radiofrequency Ablation of Osteoid Osteomas.

The aim of this study was to evaluate treatment of osteoid osteomas using bipolar radiofrequency ablation (RFA) and patients' quality of life before and after therapy. We retrospectively evaluated patients who underwent bipolar RFA of osteoid osteomas between 2001 and 2016. We assessed patients' symptoms before and after treatment (four weeks after treatment and long-term) using a questionnaire including severity and quality of pain on a 10-point scale (1 = no pain, 10 = severe pain), motion restrictions, pain-related sleep disorders, and necessary pain medication. In addition, we evaluated technical success, complications, hospitalization length, and patients' satisfaction with treatment. This study included 62 patients (43 [69.4%] males, 26.2 ± 13.2 years). Average nidus size was 5.7 ± 2.6 mm. The rate of technical success was 100%. All RFAs were performed without any complications. One patient showed a recurrence, resulting in a recurrence rate of 1.6%, which was successfully treated by another session of RFA. Average hospitalization length was 1.5 ± 0.5 days. A total of 36 patients (58.1%) participated in the questionnaire, reporting an average pain severity of 8.2 ± 1.6 before RFA compared to 3.4 ± 3.0 four weeks after and an average of 2.1 ± 2.3, 6.6 years after therapy, (both p < 0.001). After therapy, 31 (86.1%) patients had no pain. The majority of patients (n = 34, 94.4%) had reduced or absent motion restriction after therapy (p < 0.001). Patient satisfaction rate was 91.7%. In conclusion, bipolar RFA is a safe and effective treatment modality for osteoid osteomas and improves quality of life by reducing pain severity and motion restrictions.

A Narrative Review of Osteoid Osteomas and an Audit on the Practice of CT-Guided Radiofrequency Ablation in the Northern Irish Population: A First in the Literature.

Introduction Osteoid osteoma is a benign condition of the bone, usually affecting young males. This retrospective study explores the demographics of osteoid osteomas in the Northern Irish population. It also aims to audit the practice of CT-guided radiofrequency ablation of osteoid osteomas at a major orthopaedic centre in Belfast, Northern Ireland, and to investigate the possible causes of treatment failure. Methods Forty-seven osteoid osteoma patients, diagnosed based on clinico-radiologic features and treated with CT-guided radiofrequency ablation, were found eligible for inclusion and analysis. We collected data from electronic health records (March 2011 to May 2022) and reviewed the radiological images and associated reports. Information about demographics, clinical indices, operative technique, clinical outcomes, biopsy results, and follow-up were also gathered. Data were then analysed using IBM SPSS Statistics for Mac, version 28.0.1.1 (14) (IBM Corp., Armonk, NY). Results The average age of patients was 19.3 years, with a male-to-female predilection of 2.1:1. The proximal and mid-tibial shafts were the most frequently involved sites. On average, patients had symptoms for 15.6 months, while the mean treatment delay period was 6.9 months. Primary clinical success was observed in 37 patients (78.7%), while ten patients had a clinical failure. Two out of the 10 patients with treatment failure underwent subsequent successful ablations, raising the secondary clinical success rate to (83.0%). Chi-Square association tests found no correlation between primary treatment outcomes and other qualitative variables (gender, bone type, lesion location, and Kayser classification). Moreover, binary logistic regression tests found no predictability of age and treatment delay on treatment outcomes. The overall observed complication rate was 4%, with only one significant side effect reported (third-degree skin burn). Conclusion We concluded that the demographics of osteoid osteomas in the Northern Irish population are comparable to what is previously established in the literature. Furthermore, we reasoned that CT-guided radiofrequency ablation is an efficient, safe, and effective minimally invasive technique in the management of osteoid osteomas.

Comparative Analysis of Percutaneous Excision and Radiofrequency Ablation for Osteoid Osteoma.

BACKGROUND This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of osteoid osteoma. MATERIAL AND METHODS We evaluated 40 patients with osteoid osteoma who underwent either percutaneous excision or radiofrequency ablation between 2012 and 2015. The cohort consisted of 10 female and 30 male patients, with a mean age of 15.1 years (range: 4-27 years) and a mean follow-up time of 19.02 months (range: 11-39 months). Percutaneous excision was performed in 20 patients, while radiofrequency ablation was performed in the remaining 20 patients. RESULTS The success rates of percutaneous excision and radiofrequency ablation were comparable, with unsuccessful outcomes observed in 10% and 5% of patients, respectively. The reasons for failure in the percutaneous excision group were attributed to a marking error and incomplete excision of the wide-based nidus. Complications were limited to pathological fracture (n=1) and deep infection (n=1) in the percutaneous excision group, while no complications were encountered in the radiofrequency ablation group. CONCLUSIONS Both percutaneous excision and radiofrequency ablation demonstrate high success rates in treating osteoid osteoma. However, radiofrequency ablation offers the advantage of a quicker return to daily activities without the need for activity restrictions or splints. While being a more cost-effective option, percutaneous excision should be considered cautiously to minimize potential complications.

Abstract No. 320 Radiofrequency ablation of osteoid osteoma: factors associated with clinical success

To determine the clinical success rate of radiofrequency ablation (RFA) as treatment for osteoid osteoma, and evaluate the effect of intra-procedural impedance errors, nidus size, and intra-articular location on the clinical success rate

Cone beam computed tomography (CBCT) guidance is helpful in reducing dose exposure to pediatric patients undergoing radiofrequency ablation of osteoid osteoma

PurposeTo assess efficacy and safety of cone beam computed tomography (CBCT) in the radiofrequency ablation (RFA) of osteoid osteoma (OO) in children and adolescents, and to compare technical success, clinical success, radiation dose and procedure duration time of CBCT guidance to conventional computed tomography (CT) guidance.Materials and methodsBetween 2015 and 2019, 53 consecutive percutaneous RFA were performed on pediatric patients with CBCT or conventional CT guidance, respectively, in 24 and 29 children and adolescents with 24-month follow-up. Dose area product (DAP) and dose length product (DLP) were recorded, respectively, for CBCT and conventional CT and converted to effective doses (ED).ResultsCBCT and conventional CT groups were similar in terms of patient age and weight, tumor size and tumor location. Technical success was achieved in all cases. Primary clinical success was 91.67% (22/24) for the CBCT group and 89.66% (26/29) for the conventional CT group. Mean DAP was 64.75Gycm2 (range 6.0–266.7). Mean DLP was 972.62mGycm (range 337–2344). ED was significantly lower in the CBCT group compared to the conventional CT group (0.34 mSv vs. 5.53 mSv, p = 0.0119). Procedure duration time was not significantly longer in the CBCT group (102.25 min vs. 92.34 min, p = 0.065). No major complication was registered. Minor complications were observed in 4 patients (2 in CBCT; 2 in conventional CT).ConclusionsCompared to conventional CT guidance, CBCT guidance for percutaneous OO ablation shows similar technical and clinical success rates, with reduced radiation dose and equivalent procedure duration time. This technique helps sparing dose exposure to pediatric patients.

Computed tomography guided radiofrequency ablation of osteoid osteoma in children: a single center's experience.

To report a single center's experience evaluating the efficacy and safety of computed tomography-guided radiofrequency ablation for the treatment of osteoid osteoma in children. Institutional database research identified 33 symptomatic patients (≤ 18years of age; male/female ratio: 21/12, mean age 13.09 ± 3.66) with osteoid osteoma who were treated by CT-guided RFA. Technical and clinical success as well as complication rates were recorded. The duration of the procedure, the number of computed tomography scans and the results of the biopsy were assessed. Pain, prior, the following morning and 1week, 1/6/12months after the procedure were compared by means of a numeric visual scale (NVS) questionnaire. Mean lesion size was 8.28 ± 4.24mm. Mean follow-up was 23.33 ± 17.61months (range 12-62). Mean pain score prior to radiofrequency ablation was 9.06 ± 0.80 NVS units. On week 1 and 1/6/12months, all patients were pain-free reporting 0 NVS units (p < 0.05). The mean procedure time was 54min (range 51-59) and a mean of 7 CT scans were performed during the ablation session. RF electrode was successfully placed in the center of the nidus in all cases. In our study, none of our patient experienced recurrence of the pain, nor complications. The present study demonstrates that percutaneous CT-guided radiofrequency ablation constitutes a safe and effective technique for osteoid osteoma treatment in children.

Effects of control temperature, ablation time, and background tissue in radiofrequency ablation of osteoid osteoma: A computer modeling study.

To study the effects of the control temperature, ablation time, and the background tissue surrounding the tumor on the size of the ablation zone on radiofrequency ablation (RFA) of osteoid osteoma (OO). Finite element models of non‐cooled temperature‐controlled RFA of typical OOs were developed to determine the resulting ablation radius at control temperatures of 70, 80, and 90°C. Three different geometries were used, mimicking common cases of OO. The ablation radius was obtained by using the Arrhenius equation to determine cell viability. Ablation radii were larger for higher temperatures and also increased with time. All geometries and control temperatures tested had ablation radii larger than the tumor. The ablation radius developed rapidly in the first few minutes for all geometries and control temperatures tested, developing slowly towards the end of the ablation. Resistive heating and the temperature distribution showed differences depending on background tissue properties, resulting in differences in the ablation radius on each geometry. The ablation radius has a clear dependency not only on the properties of the tumor but also on the background tissue. Lower background tissue's electrical conductivity and blood perfusion rates seem to result in larger ablation zones. The differences observed between the different geometries suggest the need for patient‐specific planning, as the anatomical variations could cause significantly different outcomes where models like the one here presented could help to guarantee safe and successful tumor ablations.

Computed tomography guided radiofrequency ablation of osteoid osteoma in technically challenging locations: Tracking through the opposite cortex

Computed tomography (CT)-guided percutaneous radiofrequency (RF) ablation is an established minimally invasive treatment option of osteoid osteoma. The standard technique involves the percutaneous advancement of an RF probe under CT-guidance through the cortex overlying the nidus of osteoid osteoma in a plane oriented perpendicular to the cortex. In certain specific scenarios, aiming the osteoid osteoma nidus through the overlying cortex is not feasible either due to technical limitations or due to the potential risk of complications. The nidus can be approached through the opposite unaffected cortex in these situations, obviating the need for surgical excision. Performing CT-guided RF ablation of osteoid osteoma through the opposite unaffected cortex is a technically demanding procedure; and, thus requires a high level of expertise. There is a paucity of literature highlighting the RF ablation procedure in technically challenging locations and thus forms the cornerstone of our current technical note.

Imaging-guided radiofrequency ablation of osteoid osteoma in typical and atypical sites: Long term follow up.

PurposeTo assess efficacy and safety of imaging-guided radiofrequency ablation (RFA) of Osteoid Osteoma (OO) in both typical and atypical sites.Methods and materialsBetween January 2014 and March 2019, 102 consecutive percutaneous RFA were performed and retrospectively reviewed. The procedures were performed using a RFA bipolar ablation system (Covidien, exposed tip of 0.7-1cm), under Computed Tomography (CT) guidance or using a navigation system (Masmec) under CT and Cone Beam CT (CBCT) guidance. Patients were followed up over 24 months. Clinical success and recurrences were considered on the base of established criteria. In patients with clinical failure and/or imaging evidence of relapse, retreatment was considered.ResultsAdministered power per-procedure was ≤8 W (mean temperature, 90°C). The pre-procedure average value of visual analog scale (VAS) was 8.33+/-0.91. Primary and secondary success rate 96.08% (98/102) and100% (102/102), respectively. No major complication was described. Technical success was proved in every patient by CT scan acquisition after needle positioning. Relapse and tumour location were significantly correlated (p-value = 0.0165). The mean dose-length product was 751.55 mGycm2. Advanced bone healing was noted in 68 lesions after 1y-follow up and in 86 lesions after 2y-follow up.ConclusionImaging-guided percutaneous RFA is a highly effective technique for OO, both in typical and atypical sites. CT or CBCT guidance, navigation systems and operator experience grant the technical success, which is the most crucial parameter affecting outcome.

Computerized tomography-guided radiofrequency ablation for osteoid osteoma: preliminary results

Computerized tomography-guided radiofrequency ablation for osteoid osteoma: preliminary results

A retrospective comparison of percutaneous radiofrequency ablation of osteoid osteoma using three anesthesia modalities

Objectives: The objectives of the study were to compare the safety and effectiveness of ultrasound-guided regional anesthesia (USGRA) with monitored anesthesia care (MAC) plus light sedation (MAC + LS) versus MAC with deep sedation (MAC + DS) versus general anesthesia (GA) for percutaneous radiofrequency ablation (PRFA) of lower extremity osteoid osteoma (OO). Material and Methods: Patients who underwent PRFA of lower extremity OO from May 2016 to February 2020 were retrospectively reviewed. Three groups were constructed based on the primary anesthetic utilized: (i) USGRA with MAC + LS, (ii) MAC + DS, and (iii) GA. USGRA patients were administered sciatic or tibial nerve blocks using local anesthetic (LA) mixtures consisting of 1.5% mepivacaine ± 2% lidocaine or 2% chloroprocaine. Data were collected on the frequency of conversion to GA, post-procedure ambulatory falls, prolonged neurosensory blockade, technical success of the block, post-procedure visual analog pain scale (VAS), milligram morphine equivalent (MME) administered, procedure and recovery times, and time to resolution of the block. Data were also collected on patient age, sex, and the tumor size and location. Kruskal–Wallis and Pearson’s Chi-squared tests were performed to compare outcomes in the three study groups. Results: Nineteen patients (12 men; mean age 20.9 ± 5.9 years) with a median tumor volume of 66 mm3 [IQR 36, 150] were included. Lesion locations included the tibia (10 cases), femur (4 cases), fibula (3 cases), and calcaneus (2 cases). Four patients were provided USGRA and MAC + LS, eight patients underwent MAC + DS, and seven patients received GA. There were no significant differences in patient demographic characteristics between the three study groups. Technical success was achieved in all four patients receiving USGRA. None required conversion to GA, had post-procedure ambulation difficulty, or prolonged neurosensory deficits. Post-procedure VAS score was 0 at all measured time intervals, and no USGRA patients required opioids. Conversely, patients receiving MAC + DS or GA had varying mean VAS scores (GA: 1.8 ± 0.9; MAC + DS: 1.7 ± 1.7) and opioid requirements (median [IQR]) (GA: 0 [0, 0] MME; MAC + DS: 0 [0, 3.75] MME). Tumor volumes &gt;100 mm3 frequently required opioid analgesia. VAS scores were significantly lower in USGRA patients at 30 min post-recovery area arrival (P = 0.027) and on average over 0–120 min post-recovery area arrival (P = 0.016). Procedure duration was similar between the three anesthesia groups (P = 0.939). There was no significant difference in mean recovery times in the USGRA group (230 ± 111 min) compared to the MAC + DS (136 ± 71 min) or GA (113 ± 34 min) groups (P = 0.305). Of note, both time to USGRA resolution (254 min) and recovery time (70 min) were quickest in the patient who received a mixture of 1.5% mepivacaine and 2% chloroprocaine. Conclusion: USGRA can be implemented safely and effectively for PRFA of OO as an alternative primary anesthetic technique. It decreases post-procedural discomfort without ambulation difficulty, prolonged neurosensory deficit, or recovery time. The potential for prolonged block duration may be addressed using a mepivacaine/chloroprocaine LA mixture for periprocedural analgesia with quick resolution.

Navigation-guided radiofrequency ablation for osteoid osteoma in the lumbar spine with a continuous cooling system for preventing neural damage: A report of two cases

IntroductionOsteoid osteoma (OO) is a benign but painful tumour that arises from osteoblasts. Spinal lesions account for 20% of OOs. Surgical excision of spinal OO has been the standard treatment when conservative therapy is not effective. However, excisional surgery can lead to spinal instability and sometimes necessitates stabilization with spinal instrumentation. Radiofrequency ablation (RFA) is an attractive option for treating spinal OO, but thermal damage to neural tissues limits its application when the OO is located adjacent to neural tissues. Case presentationWe report novel 2 cases using navigation-guided RFA for OO in the lumbar spine with a continuous cooling system for preventing neural damage. During the 5 min ablation at 90 °C, the temperature at the nerve roots adjacent to the OO was maintained at <30 °C. No neurological impairment was observed postoperatively. The symptoms caused by OO disappeared immediately after the surgery, and clinical recovery was maintained for 5 and 2 years postoperatively in Cases 1 and 2, respectively. DiscussionDirect placement of the cooling system enables both sufficient ablation and neuroprotection. The navigation system enables clinicians place the RFA probe at a precise position even in cases of OO in complex anatomical structures. To our best knowledge, this is the first report of the combined use of the navigation and cooling systems. ConclusionsThis novel combinatory use of navigation-guided RFA and continuous cooling will safely expand the scope of RFA application for spinal OO by preventing neural damage and preserving spinal structure.

Impact of Magnetic Resonance Imaging (MRI) Findings on Management of Symptomatic Patients Following Radiofrequency Ablation (RFA) of Osteoid Osteoma (OO)

The purpose of this study is to assess the impact of MRI findings on management of symptomatic patients following RFA of OO. Retrospective review of 43 patients with RFA for OO between June 2010 and June 2017 was performed. Patient, nidus, and ablation data were reviewed. Pre- and 6–8 weeks post-procedural MRI (n = 32) were compared for coverage of nidus by ablation zone, bone marrow edema, nidus hyperintensity, and other findings. Baseline pain levels and analgesic use were compared with post-procedural follow-up visit at 6–8 weeks. Three groups of clinical and MRI outcomes of complete (CR), partial (PR), and no response (NR) were defined. A weighted kappa statistic was used to assess for agreement. Clinical responses were CR in 34/43 (79.1%, 95% CI: 64.0–90.0%), PR in 8/43 (18.6%), and NR in 1/43 (2.3%) patients. All 19/32 patients with MRI CR experienced clinical CR. One patient with MRI NR had clinical NR. All 7/32 patients with clinical PR had MRI PR. All 4/43 complications were in MRI PR or NR groups. Substantial agreement was observed between MRI and clinical outcomes (kappa: 0.69, 95% CI: 0.45–0.95). MRI helped determine etiologies in all symptomatic patients and their management (n = 8). MRI is recommended for symptomatic patients after ablation.

CT-guided radiofrequency ablation of osteoid osteoma: established concepts and new ideas.

Osteoid osteoma is a painful benign bone tumour of children and young adults with characteristic clinico-radiological features depending upon the location of the lesion. Intraoperative visualisation of the nidus is difficult and therefore curative surgery is often associated with excessive bone removal, significant perioperative morbidity and potential need of bone grafting procedures. With advancement in cross-sectional imaging and radiofrequency ablation (RFA) technology, CT-guided RFA has emerged as the treatment of choice for the osteoid osteoma. This procedure involves accurate cannulation of the nidus and subsequent thermocoagulation-induced necrosis.Multidisciplinary management approach is the standard of care for patients with osteoid osteoma. Appropriate patient selection, identification of imaging pitfalls, pre-anaesthetic evaluation and a protocol-based interventional approach are the cornerstone for a favourable outcome. Comprehensive patient preparation with proper patient position and insulation is important to prevent complications. Use of spinal needle-guided placement of introducer needle, namely, "rail-road technique" is associated with fewer needle trajectory modifications, reduced radiation dose and patient morbidity and less intervention time. Certain other procedural modifications are employed in special situations, for example, intra-articular osteoid osteoma and osteoid osteoma of the subcutaneous bone in order to reduce complications. Treatment follow-up generally includes radiographic assessment and evaluation of pain score. Dynamic contrast-enhanced MRI has been recently found useful for demonstrating post-RFA healing.

CT-guided radiofrequency ablation for osteoid osteomas: a systematic review.

CT-guided radiofrequency ablation (CT-RFA) is considered to be the gold standard for treatment of osteoid osteoma (OO) yet treatment failures (TFs) continue to be reported. This systematic review was conducted to evaluate factors associated with TF, such as ablation time, lesion location, and patient age as well as evaluating how TF has trended over time. Original studies reporting on patients undergoing CT-RFA of OO published between 2002 and 2019 were identified. TF was defined as patients with (1) recurrent or persistent pain +/- (2) imaging evidence of persistent OO. TFs were subdivided into those occurring after the index procedure (primary TF) or those occurring after repeat RFA (secondary TF). Subgroup analysis was performed for TF based on the study date (2002-2010 or 2010-2019), time duration of ablation at 90°C (6min or > 6min), patient age, and tumor location (spinal vs. appendicular). Sixty-nine studies were included for a total of 3023 patients. The global primary TF rate was 8.3% whereas the secondary TF rate was 3.1%. The TF rate reported in studies published after 2011(7%) was about half that during the earlier time period 2002-2010 (14%). There was no statistical difference in TF corrected for age, OO location, or duration of ablation (respectively p = 0.39, 0.13, and 0.23). The global complication rate was 3%, the most frequent being skin burns (n = 24; 0.7%). A decrease in TF observed between 2011-2019 compared to 2002-2010 may reflect improvements in operator technique or advancements in equipment. Duration of ablation, patient age, or location of OO failed to significantly correlate with TF. • CT-guided radiofrequency ablation of osteoid osteomas is a safe technique with a low rate of treatment failure (8.3% failure rate after the primary radiofrequency reducing to 3.1% following a secondary treatment). • The treatment failure rate has decreased over time, possibly due to an improved understanding of the disease process, better technique, and advances in equipment. • Duration of ablation, patient age, or lesion location did not significantly correlate with treatment failure.

Role of CT-Guided Radiofrequency Ablation of Osteoid Osteoma in Long Bones

Role of CT-Guided Radiofrequency Ablation of Osteoid Osteoma in Long Bones

Computed Tomography-Guided Radiofrequency Ablation of Osteoid Osteoma in Atypical Sites: Efficacy and Safety in a Large Case Series

Although computed tomography (CT) guided radiofrequency ablation (RFA) is accepted as the gold standard treatment for osteoid osteoma (OO) in extremities, most researchers have omitted OO in critical sites. We aimed to evaluate the efficacy and safety of CT-guided RFA in the management of OO in atypical sites. A prospective interventional study conducted on 34 patients (12 women and 22 men; mean age, 22.3 ± 3.5 years; range, 12-48 years) with OO in atypical sites. All patients were treated with CT-guided RFA. All procedures were performed under general anesthesia using a single straight, rigid RF electrode for 6 minutes at 90°C. All patients were followed up; technical and clinical successes of treatment were evaluated. The severity of pain was assessed on a visual analogue scale (VAS). CT-guided RFA was performed in all patients with 100% technical success and 100% primary clinical success. All patients had complete pain relief and returned to their quality of life without further analgesics within 1 month after the procedure. All procedures were successfully completed without any major complications. The mean preprocedure VAS score dropped to zero by the end of the first week with a highly statistically significant difference (p < 0.001). CT-guided RFA is a safe and effective procedure in the management of OO in atypical sites with 100% primary success rate, 0% long-term recurrence rate, and very low complication rate.

A kéz osteoid osteomáinak kivizsgálása és műtéti ellátása

Introduction: Osteoid osteoma is a rare benign bone tumor displaying typical clinical symptoms and radiological signs in most cases. Characteristic symptoms are nocturnal pain alleviated by non-steroid antiinflammatory drugs. Radiological findings are also characteristic, the central osteolytic 'nidus' is surrounded by reactive sclerosis. These lesions are rare in the hand, typical symptoms may be absent, furthermore, atypical symptoms may occur. Characteristic radiographic signs may also be missing. Therefore, diagnosis may prove difficult. In the case of radiological/clinical suspicion, HRCT (high-resolution CT) is recommended. Aim: Our aim is to summarize the pathophysiology, occurrence and clinical features of these lesions and also the difficulties that accompany diagnosis on the hand. Treatment options will also be discussed. Method: Retrospective analysis was performed at Semmelweis University, Department of Orthopedics, between March 2014 and December 2018. Inclusion criteria were: patients who had undergone treatment for osteoid osteoma during this period. Data from the 6 patients who have undergone open surgery for osteoid osteoma of the hand will be presented as case reports. Results: During this period, a total of 112 patients were treated for osteoid osteoma at our Department, 8 lesions were found on the hand (7%). Among the cases presenting on the hand, typical nocturnal pain was absent in 3 cases, and in 1 case the pain did not respond to non-steroid antiinflammatory drugs. Open surgery and curettage was performed in 6 cases with good results. Conclusion: Osteoid osteoma on the hand is rare, typical symptoms may be missing, and atypical symptoms may occur. Radiographic findings may be nondescript, HRCT is recommended in the case of clinical suspicion. Performing radiofrequency ablation for osteoid osteoma of the hand may pose difficulties, curettage is the gold standard of treatment. Curettage alleviates symptoms well. Orv Hetil. 2020; 161(7): 263-268.

Technical and nidus-specific factors associated with adequacy of intraprocedural biopsy samples preceding radiofrequency ablation of osteoid osteoma

PurposeTo examine the diagnostic yield of intraprocedural percutaneous biopsy performed at the time of radiofrequency ablation of suspected Osteoid Osteoma (OO) and identify technical and nidus-specific factors associated with diagnostic adequacy. Materials and methodsFollowing IRB approval, a total of 42 patients (male: 28, female: 14; mean age: 29 years) who underwent intraprocedural biopsy immediately prior to RFA between June 2010 and June 2017 were retrospectively identified. The nidi were located in various locations. The nidi had a mean size of 6.3 mm (range: 3–11 mm, Standard deviation (SD): 2.26). Core biopsies were performed by one of 15 operators. Biopsies were performed with two needle types ranging from 11-G to 15-G with a mean number of samples of 1.8 (range: 1–5, SD: 1.01). Electronic records and imaging were reviewed for demographics, nidus characteristics, biopsy details and diagnostic yield. Multivariate logistic regression of nidus-specific and biopsy-specific factors was performed. ResultsA total of 22/42 (52.3%) of the biopsies were adequate for histological diagnosis of OO. For the two experienced operators, the diagnostic yield was 67% (6/9) and 80% (8/10). Biopsy adequacy was significantly correlated with presence of an osteoid matrix (p = 0.03), obtaining >1 core sample (p = 0.03), the needle track passing through the nidus (p = 0.0003) and thinner (2.5 mm) intraprocedural CT slices (p = 0.03). On multivariate analysis, use of thinner intraprocedural CT slices was found to be associated with adequate biopsy (p = 0.02). ConclusionIntraprocedural percutaneous biopsy samples of nidi highly-suspected to be OO at the time of RFA were diagnostic in 52% of patients. Multivariate analysis shows thinner intraprocedural CT slices to be a significantly associated with biopsy adequacy.