Efficacy of a Second Brain Biopsy for Intracranial Lesions after Initial Negativity

Abstract

Background and Purpose The rationale for performing a second brain biopsy after initial negativity is not well evaluated in the literature. This study was designed to 1) assess the efficacy of a second brain biopsy when the first biopsy was nondiagnostic, 2) identify possible factors associated with an increased diagnostic rate in the second biopsy, and 3) analyze additional morbidity induced by the second biopsy. Methods We performed a retrospective cohort study from 2009 to 2019, during which 1,919 patients underwent a brain biopsy, including 30 who were biopsied twice (1.6%). The specific histological diagnosis rate, diagnosis-associated factors, and complication rate were assessed for the 30 twice-biopsied patients. Results The second biopsy allowed a specific histological diagnosis in 86.7% of the patients who had initially undergone a nondiagnostic brain biopsy [odds ratio (OR)=7.5, 95% confidence interval (CI)=3.0-18.7, p<0.001]. The multivariate analysis showed that only prebiopsy corticosteroid administration (OR=2.6, 95% CI=1.1-6.0, p=0.01) was an important factor in predicting a nondiagnostic biopsy. None of the patients developed a symptomatic complication after the first biopsy, while two (6.0%) patients experienced a transient complication after the second biopsy (p=0.49). Conclusions Performing a second brain biopsy in patients who have an initial nondiagnostic biopsy is effective in most cases. We advocate that a second biopsy be systematically considered in the diagnosis algorithm of these patients after it has been verified that molecular testing cannot help to obtain a diagnosis. Corticosteroid administration can lead to nondiagnostic biopsies and should be avoided when possible during the prebiopsy period.

Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

“…The rate of final diagnosis established with brain biopsy in ICU patients was high in our series (75.9%) and comparable to that obtained in our control group of non-ICU patients (74.9%) and even with recent studies published in non-ICU patients (6)(7)(8). Furthermore, although 24.1% of the biopsies were noncontributory for a diagnosis, they excluded infectious diseases or malignancies, thereby enabling therapeutic management to be adapted accordingly (20)(21)(22)(23). Since the mid-2010s, the progress of metagenomic next-generation sequencing on brain samples has enabled diagnoses that could not be achieved with usual microbiological analyses.…”

Advances, technological innovations, and future prospects in stereotactic brain biopsies

“…One of the main risks of stereotactic biopsy is to provide a sample that is non-contributory to a diagnosis. In a case series of patients with brain tumors, the rate of negative biopsies is close to 5%, exposing the patient to a second biopsy with potential morbidity and additional health care costs [ 8 , 20 , 53 ]. In patients biopsied for cryptogenic neurological disease, this rate reaches 30% [ 3 , 36 – 38 ].…”

“…Complications following a brain biopsy are rare, but like all neurosurgical procedures, they carry some risks, such as seizures, brain edema, or infection [ 52 ]. The most specific and frequent complications related to this procedure are negative sampling, requiring a second biopsy procedure [ 8 ], and brain hemorrhage with potentially serious consequences [ 53 ]. In a mission to become safer and more effective, constant innovations are being made in this field of neurosurgery.…”

Comparison meta-analysis of intraoperative MRI-guided needle biopsy versus conventional stereotactic needle biopsies

“… 3 , 4 However, the likelihood of definitive tissue diagnosis decreases with smaller tumors or tumors with significant regional histologic heterogeneity. 5 In cases where tissue diagnosis is not achieved in the first procedure, a second SNB achieved definitive diagnosis in 90% of the cases, 6 suggesting technical challenges associated with SNB rather than the intrinsic properties of the lesion as the underlying cause for diagnostic failures. While the likelihood of procedural complication is low, with reported postoperative morbidity generally <10%, 7 , 8 the likelihood of complication increases with the number of samples taken, 9 with the number of trajectories to the lesion, 10 and for lesions in the eloquent cerebrum or deep gray matter/brainstem.…”