Stereotactic biopsy for intracranial lesions: clinical-pathological compatibility in 60 patients

Abstract

-Objective: Image guided stereotactic biopsy (SB) provides cerebral tissue samples for histological analysis from minimal lesions or those that are located in deep regions, being crucial in the elaboration of therapeutic strategies, as well as the prevention of unnecessary neurosurgical interventions. Method: Sixty patients with central nervous lesions underwent SB from November 1999 to March 2008. They were followed up to 65 months. Preoperative diagnosis was based on clinical presentation and neuro-radiological features, pathologic diagnosis, clinical outcome. The compatibility of these findings with the pathologic diagnosis was analyzed. Results: Considering diagnosis confirmation when inflammatory hypothesis were made, our accuracy was of 76%, with 94% of those cases having clinic-pathological correspondence after an average of 65.2 months of follow up. Considering diagnosis confirmation with the preoperative hypothesis of neoplasm, our accuracy was of 69% with 90% of these cases having clinic-pathological correspondence after an average of 47.3 months of follow-up. Morbidity rate was of 5% and mortality was zero. The diagnosis rate was 95%. Conclusion: Stereotactic biopsy represents a safe and precise method for diagnosis. Anatomic and histopathological analyses have high compatibility with long-term clinical outcome.KEY WORDS: stereotactic biopsy, morbidity, accuracy, pathology.Biopsia estereotáctica para lesões intracranianas: compatibilidade clínico patológica em 60 casos resumo -Objetivo: A biopsia estereotáctica (BE) guiada por imagem propicia amostras de tecido cerebral para análises histológicas, sendo decisiva na estratégia terapêutica e prevenção de intervenções neurocirúrgicas desnecessárias. Método: 60 pacientes com lesões do sistema nervoso central foram submetidos à biópsia estereotáctica no período de novembro de 1999 a março de 2008. Foram analisados a acurácia do método, a capacidade de confirmar o diagnóstico clínico pré-operatório e o comportamento evolutivo com sua compatibilidade com o diagnóstico patológico. Resultados: As três lesões mais freqüentes foram: neoplasias neuroepiteliais, processos inflamatórios e infecções. Considerando a confirmação diagnóstica quando pensava-se em lesão inflamatória, nossa acurácia foi 76%, com 94% destes casos tendo compatibilidade clínico patológica após média de 65,2 meses de acompanhamento. Considerando a confirmação diagnóstica com a hipótese pré-operatória de lesão neoplásica, nossa acurácia foi 69%, com 90% destes casos tendo compatibilidade clínico-patológica após média de 47,3 meses de acompanhamento. O índice de morbidade foi 5%. A mortalidade foi nula e o índice de diagnóstico foi 95%. Conclusão: A biopsia estereotáctica é um método seguro e preciso para o diagnóstico. O exame anátomo-patológico possui alta compatibilidade com a evolução clínica dos doentes a longo prazo. PALAVRAS-CHAVE: biopsia estereotáctica, morbidade, acurácia, anatomopatológico.

Navigation-Guided Endoscopic Biopsy for Intraparenchymal Brain Tumor

“…The diagnostic yield in our series is comparable to that of previous reports. 2,5,6,[8][9][10]15,17,[21][22][23][24]27) However, the failure in 6.8% is not negligible. To find possible solutions to improve the diagnostic yield, we analyzed which factors were associated with higher accuracy of sampling the target points in 3 types of biopsies.…”

“…These methods have advantages and disadvantages in sampling accuracy, approach to deep lesions, and sample volume. 2,5,6,[8][9][10]15,17,[21][22][23][24]27) Several case series have demonstrated that biopsy also has limitations in the rate of successful diagnosis (diagnostic yield) compared to partial/gross total resection via open craniotomy. 4,12,16,17,22,27) The reported diagnostic yields of frame-based biopsies were 66% to 99.3%, 6,8,10,22,27) and those of frameless biopsies were 89% to 93.8%.…”

Diagnostic yield of stereotactic needle-biopsies of sub-cubic centimeter intracranial lesions

“…In our series, diagnostic yield from biopsies of lesions >1 cm 3 (94.8%) was comparable to previously published rates of 90-96% for stereotactic brain biopsies without size stratification. [5821] Biopsies of the <1 cm 3 lesions, in contrast, were associated with a lowered diagnostic yield relative to the >1 cm 3 lesions (76.2%, P = 0.0081).…”

“…First, our study suggest that the risk of a nondiagnostic biopsy for <1 cm 3 lesions are significantly higher than most biopsies in general. [5821] This is an issue that should be carefully reviewed during the informed consent for biopsy of <1 cm 3 intracranial lesions. Second, given the inherent technical challenges associated with such biopsies, referral to centers where experienced stereotactic neurosurgeons and neuro-pathologists are available warrants consideration.…”

“…[424] In terms of safety, complications related to stereotactic biopsy ranged 1-8%. [1258102123] In terms of diagnostic yield, several large series suggest that tissue diagnosis can be attained in >90% of the biopsies. [25892123]…”