Reliability of histological diagnosis including grading in gliomas biopsied by image-guided stereotactic technique

Abstract

We report clinical and pathological data of 419 image-guided stereotactic biopsies. In the present series the diagnostic yield, estimated by comparing the original histological diagnoses with follow-up data, was found to be approximately 94% in gliomas. As it has been suggested that malignancy of astrocytic gliomas may be considerably underestimated in the small tissue samples obtained by stereotactic biopsy, we have reviewed 160 adult, diffuse supratentorial astrocytic tumours, correlating the original Kernohan tumour grades with survival. In this grading system, although there was generally a good correlation between histological grade and survival probability (P < 0.0001), no distinction could be made between the grade 3 (anaplastic astrocytoma) and grade 4 (glioblastoma) groups. Tumour grades obtained by applying the criteria of the more recent Daumas-Duport grading system were also determined and correlated with survival. These latter tumour grades not only correlated well with survival (P < 0.0001), but also enabled us to identify a group of patients with intermediate grade malignancy (grade 3, anaplastic astrocytoma), surviving longer than those with grade 4 tumours. Image-guided stereotactic biopsy is a useful means of providing tissue samples for histological diagnosis of brain neoplasms, including gliomas. Histological grading of adult, diffuse supratentorial astrocytic gliomas diagnosed by this technique is possible and should be carried out using an appropriate grading system.

Limitations of stereotactic biopsy in the initial management of gliomas

“…Several studies have compared the immediate biopsy diagnosis, based on frozen sections or smears, with that of the permanent biopsy sections and have reported high accuracy (Apuzzo et al, 1987;Broggi et al, 1984;Gaudin et al, 1997;Kleihues et al, 1984;Ostertag et al, 1980;Revesz et al, 1993;Willems and Alva-Willems, 1984) or have concluded that the accuracy was high, based on survival studies (Gaudin et al, 1997;Revesz et al, 1993). However, only a few studies, using small sample sizes, have addressed the accuracy of diagnoses based on the biopsy specimen relative to those based on the resected surgical specimen (Broggi et al, 1984;Chandrasoma et al, 1989;Feiden et al, 1991;Kleihues et al, 1984;Scerrati and Rossi, 1984) (Table 3).…”

Stereotactic Biopsy for Intracranial Space-Occupying Lesions: Clinical Analysis of 550 Cases

“…It is less invasive, safe and carries less risk of complication. Revesz et al [2] reported the data of 419 patients undergoing stereotactic biopsy, where the diagnostic rate of glioma reached 94%. Giunta et al [3] reported a series of 35 patients with brain stem tumors in whom the diagnosis was confirmed in 29 by stereotactic biopsy.…”

Stereotactic Biopsy of Intracranial Brain Lesions

“…Stereotactic biopsy has a reported diagnostic accuracy of 89-97% and is a reliable tool for obtaining a diagnosis in intra-axial brain lesions in adults [6][7][8][9][10][11] and children [12]. Despite the high reliability of CT scan based stereotactic biopsies, efforts are made to increase the diagnostic yield.…”