Diagnostic Delay in Patients with Osteoid Osteoma

Purpose or Learning Objective: To assess the diagnostic delay in patients with osteoid osteoma (OO) and to analyze influencing factors.

Methods or Background: All patients treated for OO at our tertiary referral center between December 1997 and February 2021 were identified retrospectively (n = 302). An expert panel of radiologists and orthopaedic surgeons verified the diagnosis. Exclusion criteria were postinterventional recurrence, missing data on symptom onset, and if no computed tomography (CT) images were available. Clinical parameters were retrieved from the local clinical information system. A senior specialist in musculoskeletal (MSK) radiology assessed the CT and magnetic resonance images.

Results or Findings: After all exclusions, we studied 162 patients (115 men, 47 women) with an average age of 24 ± 11 years. The average diagnostic delay was 419 ± 485 days (median: 275 days; range: 21–4,503 days). Sex, patient age, presence of nocturnal pain, positive aspirin test, extent of sclerosis, and location of the tumor within bone and relative to joints did not influence diagnostic delay (P > 0.05). It was, however, positively correlated with nidus size (r = 0.26; P < 0.001), and shorter with affection of long tubular bones compared with all other sites (P = 0.04). If OO was included in the initial differential diagnosis, diagnostic delay was also shorter (P = 0.007).

Conclusion: The diagnostic delay in patients with OO is independent from demographics, clinical parameters, and most imaging parameters. A long average delay > 1 year suggests low awareness of the disease. Patients with unclear imaging findings should thus be referred to a specialized MSK center or an expert in the field should be consulted in a timely fashion.

Publication History

Article published online:
26 May 2023