Image-guided frameless stereotactic biopsy without intraoperative neuropathological examination

Abstract

This technique of image-guided biopsy has high diagnostic yield with acceptably low morbidity and may be performed as a day case. Intraoperative neuropathological examination would not have increased the diagnostic yield further in this study, and its routine use may not be necessary. In the authors' department pounds sterling 70,350 (UK)/$114,522 (US) would have been saved by not using intraoperative neuropathology in this series. Therefore, intraoperative neuropathology should no longer be routinely recommended.

Stereotactic Brain Biopsy or Bronchoscopic/Transthoracic Needle Biopsy for Diagnosis of Metastatic Cancer Presenting Simultaneously in Lung and Brain: A Comparison of Safety and Efficacy

“…In the author's hands, stereotactic biopsy had a higher yield, lower morbidity, and no mortality when compared to lung biopsy. Other authors have reported similar results (Apuzzo et al, 1987;Hertel et al, 2005;Shooman et al, 2010;Stranjalis et al, 2003). It is likely that the wide range of pathologies included in the other published series of stereotactic brain biopsy may contribute to the morbidity of these procedures.…”

“…A recent review of 290 cases of CT guided biopsy reported a diagnostic biopsy in 95.5%, a 4.1% incidence of symptomatic hemorrhage (two required surgery), and a mortality of 0.8% (Ersahin et al, 2011). A recent series of 134 patients done without frozen section confirmation had a diagnostic yield of 99.3% (one targeting error) and complications in 2.2%, one of which was a conservatively treated hematoma and two of which were fatal in high grade gliomas (1.5%) (Shooman, Belli, & Grundy, 2010). In a series of 299 biopsies by 11 surgeons for all diagnoses, diagnostic yield was 90.6% with symptomatic hemorrhage in 4.4% and death in 1.3% (Chen et al, 2009).…”

Computerized tomography guided stereotactic biopsy of intracranial lesions: report of consecutive 500 cases.

“…The most significant advantages of intraoperative cytologic examination are its fastness, simplicity and having high levels of diagnosis rate (5,19,32,34). Although there are studies which argue that there is no need for a routine intraoperative neuropathological examination in SB (11,12,33), we do believe that intraoperative cytologic/histological examination is essential in order to increase the diagnostic yield and to decrease the number of biopsy specimens taken in stereotactic biopsies carried out in cases where there are no MRS/CT fusion images.…”

“…been improved with the use of neuronavigation devices; however, they are not yet as safe as framed systems, especially in terms of target acuity of small lesion biopsies, despite the presence of studies claiming the opposite (1,6,11,12,15,16,26,(31)(32)(33)37,38).…”

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ABSTRACT mass should not be taken in consideration, especially in the diagnosis of deeply located, diffused infiltrative or multiple space-occupying lesions, computerized tomography (CT) or MRI-guided stereotactic biopsies have been proven to be safe and reliable by various studies (2,4,(7)(8)(9)(11)(12)(13)15,16,18,19,(21)(22)(23)(25)(26)(27)(28)(29)(31)(32)(33)(34)(35)(36)(37)(38)

Despite the tremendous improvement in neuroradiology and nuclear medicine, especially in magnetic resonance imaging (MRI) and positron emission tomography (PET), definitive diagnosis in most brain lesions require histopathological examination. When a bulk excision of the AIm: Computed tomography (CT)-guided stereotactic brain biopsy has been performed in our clinic since March 1998.

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