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The use of radioguided surgery in the resection of osteoid osteoma
Uso de la cirugía radiodirigida en el tratamiento quirúrgico del osteoma osteoide
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Gammagrafía ósea tras la administración de <span class="elsevierStyleSup">99m</span>Tc-HDP. A) El rastreo de cuerpo completo muestra la presencia de un foco hipercaptante del trazador en el tercio medio de la tibia izquierda. B) En la imagen SPECT-CT se aprecia la localización de la lesión a nivel de su cara interna.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.R. Infante, R. Lorente, J.I. Rayo, J. Serrano, M.L. Domínguez, L. García, M. Moreno" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.R." "apellidos" => "Infante" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Lorente" ] 2 => array:2 [ "nombre" => "J.I." "apellidos" => "Rayo" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Serrano" ] 4 => array:2 [ "nombre" => "M.L." "apellidos" => "Domínguez" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "García" ] 6 => array:2 [ "nombre" => "M." 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RGSLNB: radio-guided sentinel lymph node biopsy; SLN: sentinel lymph node; PGC: portable gamma camera; ALND: axillary lymph node dissection; LS: lymphoscintigraphy; FNAP: fine needle aspiration puncture.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Jiménez-Ballvé, A. Serrano-Palacio, J.A. García-Sáenz, A. Ortega Candil, O. Salsidua-Arroyo, J.M. Román-Santamaría, A. Pelayo Alarcón, M.E. Fuentes Ferrer, J.L. Carreras-Delgado" "autores" => array:9 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Jiménez-Ballvé" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Serrano-Palacio" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "García-Sáenz" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Ortega Candil" ] 4 => array:2 [ "nombre" => "O." "apellidos" => "Salsidua-Arroyo" ] 5 => array:2 [ "nombre" => "J.M." "apellidos" => "Román-Santamaría" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Pelayo Alarcón" ] 7 => array:2 [ "nombre" => "M.E." 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The LS does not show leukocyte uptake which would suggest infection (D). 14 months follow up of this patient without antibiotic treatment, did not produce clinical evidence of infection.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "U. Granados, D. Fuster, A. Soriano, S. García, G. Bori, J.C. Martínez, M. Mayoral, P. Perlaza, X. Tomás, F. Pons" "autores" => array:10 [ 0 => array:2 [ "nombre" => "U." "apellidos" => "Granados" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Fuster" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Soriano" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "García" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Bori" ] 5 => array:2 [ "nombre" => "J.C." "apellidos" => "Martínez" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Mayoral" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Perlaza" ] 8 => array:2 [ "nombre" => "X." "apellidos" => "Tomás" ] 9 => array:2 [ "nombre" => "F." 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Infante, R. Lorente, J.I. Rayo, J. Serrano, M.L. Domínguez, L. García, M. Moreno" "autores" => array:7 [ 0 => array:4 [ "nombre" => "J.R." "apellidos" => "Infante" "email" => array:1 [ 0 => "infantetorre@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Lorente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.I." "apellidos" => "Rayo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "M.L." "apellidos" => "Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "L." "apellidos" => "García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "M." "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Traumatología, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de la cirugía radiodirigida en el tratamiento quirúrgico del osteoma osteoide" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3940 "Ancho" => 2370 "Tamanyo" => 475394 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Male patient, 26 years of age with osteoid osteoma in left lower leg. Bone scintigraphy after the administration of <span class="elsevierStyleSup">99m</span>Tc-HDP. (A) Whole body scan shows focal increased uptake in the middle third of the left tibia. (B) In the SPECT-CT images the lesion can be pinpointed to the medial surface of the tibia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The osteoid osteoma is a tumor that accounts for between 11% and 14% of benign bone tumors and 3% of all primary bone tumors. In 1930, Bergstrand first described osteoid osteomas and in 1935 Jaffe differentiated this entity from other variants. Osteoid osteomas are more commonly found in males and 50% of patients are aged between 10 and 20 years. It has been noted that they are primarily located within the bone cortex of the lower limbs.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Osteoid osteoma diagnosis is based on clinical history, radiological findings and on bone scintigraphy. The most common clinical symptom is pain, usually at night, which responds to nonsteroidal anti-inflammatory drugs (NSAIDs). A bone scintigraphy is the best imaging technique to localize the lesion, showing a characteristic double density sign.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although pain relief is the first step to take, the definitive treatment is complete resection of the tumor. However, it is often difficult to localize or determine the extent of the lesion in the operating theater. This fact, coupled with the presence of nearby neural or vascular structures complicate surgery, consequently increasing the likelihood of recurrence.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Radioguided surgery has become an established technique for sentinel node localization for certain tumors or detection of parathyroid lesions.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although the application of this technique to osteoid osteoma was described years ago, there is relatively little published information on the subject.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of our study was to assess the utility of radioguided surgery as a method of locating and treating this tumor.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Twelve patients who had been referred to our department between January 2008 and March 2014 with suspect lesions according to clinical, radiological and scintigraphic findings were evaluated retrospectively. The group consisted of 2 women and 10 men, between 9 and 44 years of age. All subjects underwent a three-phase bone scintigraphy for which a standard dose of 740<span class="elsevierStyleHsp" style=""></span>MBq of <span class="elsevierStyleSup">99m</span>Tc-hidroxidifosfonato was administered, except in children, where dose was adjusted according to weight. In the delayed phase, planar and SPECT images were obtained using either dual-headed gamma cameras (Millennium VG, GE, Haifa, Israel) or a hybrid SPECT-CT (Symbia T2, Siemens, Erlangen, Germany). The scintigraphic images revealed foci with increased uptake compatible with osteoid osteoma in all 12 patients: 4 in the femur, 3 in the tibia, 3 in the spine, 1 in the humerus and 1 in talus bone (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Tumor sizes, which were determined using CT or MRI, ranged from 0.3 to 1.7<span class="elsevierStyleHsp" style=""></span>cm. Osteoblastoma was suspected in one case.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Based on these results the patients underwent radio-guided surgery under general or spinal anesthesia. Two to three hours before surgery, patients were injected with a standard dose of 740<span class="elsevierStyleHsp" style=""></span>MBq <span class="elsevierStyleSup">99m</span>Tc-hydroxy diphosphonate which was adjusted according to weight for children. A portable gamma camera (Minicam<span class="elsevierStyleSup">®</span>) and a gamma detection probe (Europrobe<span class="elsevierStyleSup">®</span>), both cadmium telluride detectors, were used to identify the lesion with its increased activity noninvasively. During the surgical procedure, continuous comparison of tumor and surrounding healthy bone tissue activity ensured the removal of the nidus which was considered complete when activity decreased to the same levels of the healthy tissue. Excised tissue fragments were sent for histopathological analysis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients were followed up for between 6 and 45 months to monitor the possible occurrence of postoperative complications or recurrences (based on reported pain).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the patient characteristics; tumor lesions were located in all 12 patients, in eight patients, biopsy confirmed the diagnosis including one case of osteoblastoma which was described and published previously by our group.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In the other four patients the lesion was not confirmed, probably due to the use of curettage rather than en-bloc resection. A bone graft was necessary in only one of the procedures. There was only one minor postsurgical complication reported (pain in the area of the scar), which was not attributable to the implementation of radioguided surgery.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The cure rate, based on the disappearance of pain without recurrence and after a minimum follow-up of 6 months, was 100%.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Osteoid osteoma is the third most common benign bone tumor. Although it can occur at any age, most are diagnosed in the second decade of life. They commonly occur in the tibia and proximal femur and the presence of multiple lesions in the same patient is rare. An osteoid osteoma causes a dull, aching pain that is moderate in intensity but can worsen and become severe – especially at night. The pain can be relieved by salicylates and NAIDs.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,3,4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The osteoblastoma is an uncommon bone tumor. From a histological point of view, it is very similar to the osteoid osteoma and, in some cases, can only be distinguished by its size, and has been referred to as a giant osteoid osteoma.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">An initial plain radiograph will show a radiolucent area called the nidus. Bone scintigraphy allows the precise location of the nidus. The SPECT-CT is useful if poor uptake limits the quality of a planar image, and furthermore reveals the exact anatomical location of the lesion which helps in planning surgical procedures.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,12</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">With pain management, it has been found that osteoid osteoma tend to resolve spontaneously within 6–15 years. However, due to the side effects of anti-inflammatory treatment and the severity of pain, often the need for surgical resection of the nidus arises. The anatomic location of the lesion and its proximity to nerve or vascular structures may result in complications, increasing the frequency of recurrences.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6,13</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Typical surgical procedures include en-bloc resection, the marginal resection of the nidus, curettage or the use of a high speed drill. En-bloc resection has the disadvantage of requiring greater surgical approach area and, depending on the size, may require internal fixation or a bone graft, increasing the frequency of postoperative fractures and prolong the hospital stay.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Although not currently used, tetracycline administered preoperatively and immediate examination of the nidus area under ultraviolet light has been used as a method of localization and verification that the nidus has been excised. In any case, what is needed is a surgical method allowing the precise location of the lesion and its complete resection with minimal damage to the surrounding bone tissue.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">CT-guided percutaneous radiofrequency ablation yields a successful cure rate. However, there may be complications if the nidus is close to vascular or neural structures, as is true of cases found in the spine. Complications such as recurrence of pain, complex regional pain syndrome, vascular deficit or osteomyelitis have been described.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6,16</span></a> Recently, reports on the use of magnetic resonance guided focused ultrasound ablation have been published, but limited to the treatment of non-spinal osteoid osteoma.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The use of radioguided surgery allows more bone tissue to be maintained, thereby minimizing the risk of fractures or the need for grafts and shortening the recovery period. It also facilitates safer tumor resection in the cases of proximity to vital structures and dosage is less compared to CT guided resection.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">18,19</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">We consider the outcome of the use of radioguided surgery as satisfactory; complete healing was achieved in 100% of cases, with no recurrences reported, coinciding with other authors who have also reported high cure rates.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9,20</span></a> In our study, there was only one minor complication reported, pain in scar area, and in only one patient was a bone graft necessary after excision (osteoid osteoma located in the neck of the left talus).</p><p id="par0110" class="elsevierStylePara elsevierViewall">Both the visual display of portable gamma camera, and the information provided by the gamma detection probe were proven to be of great use when used in conjunction as complementary techniques. The portable gamma camera image showed the disappearance of the focus, allowing visual confirmation of complete excision of the nidus. The marked lesions were identified intra-operatively using the gamma-probe thereby guiding the surgical procedure.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The use of hybrid SPECT-CT images allowed proper planning of surgery. Nevertheless, the result of surgery was also successful in patients who only had SPECT.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Consistent with findings described in published literature, in our study, eight patients were aged between 10 and 20 years, representing 67% of the study group, 10 out of 12 were male and the most common sites of osteoid osteoma were the femur, followed by the tibia and spine.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">As for the histopathological study of excised tissue, in 77% of cases osteoid osteoma or osteoblastoma was confirmed; in four patients, diagnosis was not confirmed. Similar or lower rates have been described by other authors.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9,20</span></a> This can be explained when we consider that in many cases tumor excision is carried out in multiple fragments.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Histopathological analysis is sought after to confirm that it is the nidus which has been removed; however, it does not prove that it has been completely removed. Of course, the absence of histological confirmation of the lesion does not mean it has not been removed (either partially or completely). The reported disappearance of pain in all patients clinically confirmed complete removal of the nidus, in spite of negative biopsy reports, based on the concept that if pain had persisted after surgery, it would have meant that the lesion had not been completely removed.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Some authors have reported difficulties with radioguided surgery in the acetabular region, and in children, in the epiphyseal region due to background interference caused by uptake and activity in the bladder or growth plates.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> None of the tumors found in our study group presented in these areas. Delaying surgery to 24<span class="elsevierStyleHsp" style=""></span>h after administration of the radiotracer would increase the lesion-background index, perhaps helping to minimize such difficulties.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Finally, while some publications have assessed the utility of quantifying radiotracer uptake at tumor level in the scintigraphic image, no correlation has been found between this and the information provided by the detection probe during surgery. In our study we did not study these correlations.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8,20</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">In conclusion, the use of radioguided surgery in the treatment of osteoid osteoma showed satisfactory results, with 100% efficacy of both the location of the lesion and treatment outcome, without the presence of major postoperative complications. The method reduces time in theater and creates a feeling of increased confidence within the team involved.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres526478" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec546665" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres526477" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec546664" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-14" "fechaAceptado" => "2015-01-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec546665" "palabras" => array:3 [ 0 => "Radioguided surgery" 1 => "Osteoid osteoma" 2 => "Osteoblastoma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec546664" "palabras" => array:3 [ 0 => "Cirugía radiodirigida" 1 => "Osteoma osteoide" 2 => "Osteoblastoma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Osteoid osteoma is the third most common benign bone tumor and complete surgical resection is definitive treatment. There are a limited number of publications on the use of radioguided surgery in this type of lesion.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To assess the utility of radioguided surgery in our environment as a method of surgical treatment of this tumor.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We retrospectively evaluated 12 patients (2 women and 10 men, age range 9–44 years) with clinical and radiological suspicion of osteoid osteoma. Bone scintigraphy showed foci of pathology uptake compatible with suspected lesion in the femur (4 cases), tibia (3), vertebral column (3), humerus (1) and talus (1). Subsequently patients underwent surgical treatment by radioguided surgery after injection of a dose of <span class="elsevierStyleSup">99m</span>Tc-hydroxy diphosphonate. The nidus was removed using gamma probe and mini gamma camera, considering the technique to be completed when its counts decreased to the levels of the surrounding bone counts.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Lesions were located in all patients (12 of 12), and were confirmed histologically in eight of them, including an osteoblastoma. The cure rate was 100%, based on the disappearance of pain after a minimum follow-up of 6 months.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Use of radioguided surgery in the surgical treatment of osteoid osteoma showed satisfactory results, with 100% efficiency in both lesion location and outcome of treatment and without major postoperative complications.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El osteoma osteoide es el tercer tumor óseo benigno más frecuente, siendo su tratamiento definitivo la resección completa. Existe un limitado número de publicaciones sobre el uso de la cirugía radiodirigida en este tipo de lesiones.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Valorar la utilidad de la cirugía radiodirigida en nuestro medio como método de tratamiento quirúrgico de este tumor.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se valoraron de manera retrospectiva 12 pacientes (2 mujeres y 10 hombres, rango de edad 9–44 años) con sospecha clínica y radiológica de osteoma osteoide. Tras estudio gammagráfico óseo, se localizaron focos hipercaptantes compatibles con la patología de sospecha en el fémur (4 casos), tibia (3), columna vertebral (3), húmero (1) y astrágalo (1). Posteriormente, los enfermos fueron sometidos a tratamiento quirúrgico mediante cirugía radiodirigida tras la inyección de una dosis de <span class="elsevierStyleSup">99m</span>Tc-hidroxidifosfonato. Utilizando gammacámara portátil y sonda de detección gamma se extirpó el nidus, considerando la técnica completada cuando su actividad disminuyó a los niveles presentados por el tejido sano circundante.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Las lesiones fueron localizadas en todos los pacientes (12 de 12), confirmándose histológicamente en 8 de ellos, incluyendo un osteoblastoma. La tasa de curación, basada en la desaparición del dolor tras seguimiento mínimo de 6 meses, fue del 100%.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La utilización en nuestro medio de la cirugía radiodirigida en el tratamiento quirúrgico del osteoma osteoide mostró resultados satisfactorios, con un 100% de eficacia tanto en localización de la lesión como en el resultado del tratamiento, sin presencia de complicaciones posquirúrgicas mayores.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Infante JR, Lorente R, Rayo JI, Serrano J, Domínguez ML, García L, et al. Uso de la cirugía radiodirigida en el tratamiento quirúrgico del osteoma osteoide. Rev Esp Med Nucl Imagen Mol. 2015;34:225–229.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3940 "Ancho" => 2370 "Tamanyo" => 475394 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Male patient, 26 years of age with osteoid osteoma in left lower leg. Bone scintigraphy after the administration of <span class="elsevierStyleSup">99m</span>Tc-HDP. (A) Whole body scan shows focal increased uptake in the middle third of the left tibia. (B) In the SPECT-CT images the lesion can be pinpointed to the medial surface of the tibia.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">NEG, negative; POS, positive.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (yrs) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tumor location \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Size (cm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biopsy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up (months) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative complications \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recurrence \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right tibia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">POS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vertebra L5, left pedicle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">POS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right tibia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NEG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right femur \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">POS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left femur \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NEG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left femur \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">POS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vertebra L3, left pedicle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">POS (osteoblastoma) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left talus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NEG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right humerus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">POS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Painful scar tissue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right femur \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">POS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vertebra D11, right pedicle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NEG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left tibia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">POS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab848241.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Overview of patient characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 1 | 3 |
| 2019 February | 1 | 2 | 3 |
| 2018 June | 1 | 0 | 1 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 13 | 2 | 15 |
| 2018 January | 11 | 2 | 13 |
| 2017 December | 5 | 2 | 7 |
| 2017 November | 10 | 3 | 13 |
| 2017 October | 6 | 7 | 13 |
| 2017 September | 7 | 4 | 11 |
| 2017 August | 10 | 0 | 10 |
| 2017 July | 5 | 5 | 10 |
| 2017 February | 1 | 0 | 1 |
| 2016 December | 0 | 1 | 1 |
| 2016 October | 0 | 4 | 4 |
| 2016 September | 0 | 2 | 2 |
| 2016 August | 0 | 2 | 2 |
| 2016 July | 0 | 1 | 1 |
| 2016 June | 1 | 2 | 3 |
| 2016 May | 0 | 6 | 6 |
| 2016 April | 0 | 7 | 7 |
| 2016 March | 0 | 13 | 13 |
| 2016 February | 0 | 1 | 1 |
| 2016 January | 0 | 1 | 1 |
| 2015 November | 0 | 1 | 1 |
| 2015 October | 0 | 1 | 1 |
| 2015 September | 0 | 2 | 2 |
| 2015 August | 0 | 1 | 1 |
| 2015 July | 0 | 3 | 3 |
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