Comparison of outcomes of free-hand 2-dimensional ultrasound-guided versus navigated 3-dimensional ultrasound-guided biopsy for supratentorial tumours: a single-institution experience with 125 cases

Abstract

Purpose The purpose of this study was to evaluate the relative utility and benefits of free-hand 2-dimensional intraoperative ultrasound (FUS) and navigated 3-dimensional intraoperative ultrasound (NUS) as ultrasound-guided biopsy (USGB) techniques for supratentorial lesions. Methods All patients who underwent USGB for suspected supratentorial tumours from January 2008 to December 2017 were retrospectively analyzed. The charts and electronic medical records of these patients were studied. Demographic, surgical, and pathological variables were collected and analyzed. The study group consisted of patients who underwent either FUS or NUS for biopsy. Results A total of 125 patients (112 adults and 13 children) underwent USGB during the study period (89 FUS and 36 NUS). NUS was used more often for deep-seated lesions (58% vs. 18% for FUS, P<0.001). The mean operating time for NUS was longer than for FUS (156 minutes vs. 124 minutes, P=0.001). Representative yield was found in 97.7% of biopsies using FUS and in 100% of biopsies using NUS (diagnostic yield, 93.6% and 91.3%, respectively). The majority of lesions (89%) were high-grade gliomas or lymphomas. Postoperative complications were more common in the NUS group (8.3% vs. 1.2%), but were related to the tumour location (deep). Conclusion Despite the longer operating time and higher rate of postoperative complications, NUS has the benefit of being suitable for biopsies of deep-seated supratentorial lesions, while FUS remains valuable for superficial lesions.

Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery

“…In the aforementioned series, which has been the largest research on NUS-guided biopsies, Allouch et al utilized 2DUS coupled with a biopsy guide and superimposed the trajectory on the sonograms for guidance, achieving a diagnostic yield of 92% [66]. Patil et al obtained a similar yield of 92.8% in their study of 125 NUS-guided biopsies of supratentorial tumors [67]. The direct use of NUS can have more advantages and benefits, including repeated, high-quality intraoperative updates that can be helpful and useful for guiding glioma biopsy and resection, as well as brain shift control [67].…”

Navigated ultrasound-based image guidance during resection of gliomas: practical utility in intraoperative decision-making and outcomes

“…In our experience, we have found NUS to be very useful for performing biopsies as well as resecting glioblastomas and nonenhancing gliomas. [4][5][6] The major purpose of NUS (as with most image guidance and intraoperative adjuncts) is lesion localization (which is used for biopsy targeting as well as for lesion identification and trajectory planning during the resection of some tumors, especially well-delineated masses like metastases and some gliomas) and resection control (primarily for gliomas, where NUS is used for performing serial resection scans to assess the resection in real time and plan the further progress of the surgical procedure). NUS is particularly suited for resection control, offering quick and repeated updates of the operative field/cavity without significantly interfering with the surgical workflow.…”

Navigated intraoperative ultrasonography for brain tumors: a pictorial essay on the technique, its utility, and its benefits in neuro-oncology

“…In our experience, IOUS is a very useful tool for the treatment of all kinds of brain tumors [ 3 , 9 ]. It is particularly useful for targeted biopsies [ 10 ] as well as the resection of intra-axial tumors [ 11 - 14 ]. Large systematic reviews and meta-analyses have also indicated that IOUS can be a very useful adjunct to improve the resections of gliomas [ 15 , 16 ].…”