[Contribution of nidus fluorescence in the surgical treatment of osteoid osteoma. Apropos of 17 cases].
OBJECTIVE
The severity of pain and functional disability contrast with the benignity and small size which characterize the osteoid osteoma. This study evaluates the clinical and histological efficiency of an intraoperative localization of the nidus by the tetracycline fluorescence test which is based on histomorphometric bone labeling techniques.


METHODS
17 out 25 osteoïd osteoma, operated between 1987 and 1995, had tetracycline fluorescence test. The patients received 1 gram orally during each of the 3 pre-operative days. Fluorescence under ultraviolet light was assessed on the removed specimen, and on the tumor site, before and after surgical resection.


RESULTS
At a mean follow-up of 39 months (12-85), 15 of the 17 patients (88 per cent) were painless. The result was always acquired within the first weeks after procedure. 2 patients had a primary failure due to incomplete removal of fluorescent nidus, and one was reoperated with success after one year. One patient had a false negative test although there was histological evidence of osteoid osteoma on the removed tissues with a complete relief of pain. In summary, the test was helpful in 14 cases (82 per cent) guiding "en bloc" resection or curetage, and allowing 70 per cent of histological nidus diagnosis.


CONCLUSIONS
This test is easy to carry out by pre-operative ingestion of tetracycline and only requires an ultra-violet light source. It demonstrated a good reliability which can be compared with that of more complex radio-labeling techniques or CT guided drill resections which impede histological confirmation in half of the cases. The fluorescence test allows a secure and precise procedure without complication, and we use it mainly for cancellous and superficial osteoid osteoma, and for revision of previous failed excisions. When the nidus is cortical and deeply located, radioguided techniques must be discussed.
Thomazeau
H
H
Service de Chirurgie Orthopédique et Réparatrice, Hôpital Sud, Rennes.
Langlais
F
F
Goldschild
M
M
Lancien
G
G
D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005453:Fluorescence; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010017:Osteoma, Osteoid / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D013752:Tetracycline
D013752:Tetracycline
Apport de la fluorescence du nidus dans le traitement chirurgical de l'ostéome ostéoïde. A propos de 17 cas.