Limitations of stereotactic biopsy in the initial management of gliomas

Abstract

Stereotactic biopsy is often performed for diagnostic purposes before treating patients whose imaging studies highly suggest glioma. Indications cited for biopsy include diagnosis and/or the "inoperability" of the tumor. This study questions the routine use of stereotactic biopsy in the initial management of gliomas. At The University of Texas M. D. Anderson Cancer Center, we retrospectively reviewed a consecutive series of 81 patients whose imaging studies suggested glioma and who underwent stereotactic biopsy followed by craniotomy/resection (within 60 days) between 1993 and 1998. All relevant clinical and imaging information was reviewed, including computerized volumetric analysis of the tumors based on pre- and postoperative MRI. Stereotactic biopsy was performed at institutions other than M. D. Anderson in 78 (96%) of 81 patients. The majority of tumors were located either in eloquent brain (36 of 81 = 44%) or near-eloquent brain (41 of 81 = 51%), and this frequently was the rationale cited for performing stereotactic biopsy. Gross total resection (>95%) was achieved in 46 (57%) of 81 patients, with a median extent of resection of 96% for this series. Diagnoses based on biopsy or resection in the same patient differed in 40 (49%) of 82 cases. This discrepancy was reduced to 30 (38%) of 80 cases when the biopsy slides were reviewed preoperatively by each of three neuropathologists at M. D. Anderson. Major neurologic complications occurred in 10 (12.3%) of 81 surgical patients and 3 (3.7%) of 81 patients undergoing biopsy. Surgical morbidity was probably higher in our series than it would be for glioma patients in general because our patients represent a highly selected subset of glioma patients whose tumors present a technical challenge to remove. Stereotactic biopsy is frequently inaccurate in providing a correct diagnosis and is associated with additional risk and cost. If stereotactic biopsy is performed, expert neuropathology consultation should be sought.

A Systematic Review and Meta-Analysis of Studies Examining the Use of Brain Laser Interstitial Thermal Therapy versus Craniotomy for the Treatment of High-Grade Tumors in or near Areas of Eloquence: An Examination of the Extent of Resection and Major Complication Rates Associated with Each Type of Surgery

“…There were 19 studies identified using craniotomy [3,4,7,9,10,11,12,32,33,34,35,36,37,38,39,40,41,42,43]. Of these, 6 articles were excluded [3,32,37,42,43] due to an inability to break out complications related to surgery in areas of eloquence.…”

“…Of these, 6 articles were excluded [3,32,37,42,43] due to an inability to break out complications related to surgery in areas of eloquence. Additionally, one article was excluded [12] due to the assumption that these patients were reported on in Kim et al [33] and to reduce the chance of double counting. Online supplementary Appendix 2 shows the craniotomy studies included (total of 12 craniotomy studies included).…”

“…It was found that 3 such complications occurred in these studies (table 2). There were 11 craniotomy studies totaling 1,036 patients included in this analysis [3,9,10,11,12,34,35,36,39,40,41]. There were 141 such complications that occurred (table 2).…”

“…As it relates to EOR, the published literature commonly shows that the complication rates with open craniotomy are 15% or greater [9,11,12] in patients with high-grade gliomas located in or near areas of eloquence. Further, craniotomy when used in these tumors commonly results in suboptimal resection, thereby compromising overall survival.…”

Pattern recognition of abscesses and brain tumors through MR spectroscopy: Comparison of experimental conditions and radiological findings

“…These confounding factors may compromise treatments, so a biopsy is usually performed, but it is an invasive procedure and therefore risks are involved. Also, grading of gliomas, a notoriously inhomogeneous type of tumor, has many confounding factors, to the point that approximately 38% of stereotactic biopsy diagnosis may differ from histopathological classification performed in resections from the same patient (Jackson et al, 2001). Brain tumor diagnosis would benefit much from an automated analysis of MR spectra due to these factors, helping to improve the accuracy of the radiological findings.…”