Stereotactic computed tomography–guided brain biopsy: diagnostic yield based on a series of 170 patients

Ferreira, Marcelo Paglioli; Ferreira, Nelson Pires; Filho, Arthur de Azambuja Pereira; Filho, Gustavo de Azambuja Pereira; Franciscatto, André Cerutti

doi:10.1016/j.surneu.2005.11.036

Cited by 41 publications

(29 citation statements)

References 33 publications

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“…The principal risk of a biopsy is hemorrhage. Mortality in most series is 1-2% and neurological morbidity 3-5% (201). Neurosurgical admission is stressedful for the patients, and histology is inconclusive in up to 8-12% of patients (202,203).…”

Section: Integration Of Preoperative Mrsi and Diffusion Imaging In Prmentioning

confidence: 99%

Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema

et al. 2009

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Background: Conventional magnetic resonance (MR) imaging has a number of limitations in the diagnosis of the most common intracranial brain tumors, including tumor specification and the detection of tumoral infiltration in regions of peritumoral edema. Purpose: To prospectively assess if diffusion-weighted MR imaging (DWI) could be used to differentiate between different types of brain tumors and to distinguish between peritumoral infiltration in high-grade gliomas, lymphomas, and pure vasogenic edema in metastases and meningiomas. Material and Methods: MR imaging and DWI was performed on 93 patients with newly diagnosed brain tumors: 59 patients had histologically verified high-grade gliomas (37 glioblastomas multiforme, 22 anaplastic astrocytomas), 23 patients had metastatic brain tumors, five patients had primary cerebral lymphomas, and six patients had meningiomas. Apparent diffusion coefficient (ADC) values of tumor (enhancing regions or the solid portion of tumor) and peritumoral edema, and ADC ratios (ADC of tumor or peritumoral edema to ADC of contralateral white matter, ADC of tumor to ADC of peritumoral edema) were compared with the histologic diagnosis. ADC values and ratios of high-grade gliomas, primary cerebral lymphomas, metastases, and meningiomas were compared by using ANOVA and multiple comparisons. Optimal thresholds of ADC values and ADC ratios for distinguishing high-grade gliomas from metastases were determined by receiver operating characteristic (ROC) curve analysis. Results: Statistically significant differences were found for minimum and mean of ADC tumor and ADC tumor ratio values between metastases and high-grade gliomas when including only one factor at a time. Including a combination of in total four parameters (mean ADC tumor, and minimum, maximum and mean ADC tumor ratio) resulted in sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of 72.9, 82.6, 91.5, and 54.3% respectively. In the ROC curve analysis, the area under the curve of the combined four parameters was the largest (0.84), indicating a good test. Conclusion: Our results suggest that ADC values and ADC ratios (minimum and mean of ADC tumor and ADC tumor ratio) may be helpful in the differentiation of metastases from high-grade gliomas. It cannot distinguish high-grade gliomas from lymphomas, and lymphomas from metastases. ADC values and ADC ratios in peritumoral edema cannot be used to differentiate edema with infiltration of tumor cells from vasogenic edema when measurements for high-grade gliomas, lymphomas, metastases, and meningiomas were compared.

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Section: Integration Of Preoperative Mrsi and Diffusion Imaging In Prmentioning

confidence: 99%

Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema

et al. 2009

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“…2,5,6,[8][9][10]15,17,[21][22][23][24]27) Several case series have demonstrated that biopsy also has limitations in the rate of successful diagnosis (diagnostic yield) compared to partial/gross total resection via open craniotomy. 4,12,16,17,22,27) The reported diagnostic yields of frame-based biopsies were 66% to 99.3%, 6,8,10,22,27) and those of frameless biopsies were 89% to 93.8%. 4,12,16,22,27) Especially in stereotactic biopsy, the sampling error and the small amount of tissue are the most likely reasons for the relatively low diagnostic yield, 14) although stereotactic biopsy is minimally invasive with potentially low complication risk.…”

Section: Introductionmentioning

confidence: 99%

Navigation-Guided Endoscopic Biopsy for Intraparenchymal Brain Tumor

Tsuda

Ishikawa

Zaboronok

et al. 2011

Neurol. Med. Chir.(Tokyo)

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To evaluate the efficacy of intraparenchymal brain tumor biopsy using endoscopy and a navigation system (navigation-guided endoscopic biopsy) as a diagnostic tool, a case series of intraparenchymal tumor biopsies was reviewed. Navigation-guided endoscopic biopsy was applied in 9 cases, stereotactic needle biopsy in 16 cases, and open biopsy with or without navigation system in 34 cases. In all biopsy cases, 84.7% of biopsy points were sampled accurately, and 93.2% of diagnoses by biopsy were correct. Comparison of each type of biopsy showed that the resected volumes in navigation-guided endoscopic biopsy and open biopsy tended to be larger than those in stereotactic biopsy, and the mean operation time for the open biopsy procedure was the longest. To define the most applicable device or examination method to increase sampling accuracy, various factors were analyzed in 59 procedures. Navigation-guided endoscopic biopsy was the most accurate of the three types of biopsy, although the statistical difference was not significant. Older patients, histological diagnosis of high-grade glioma or malignant lymphoma, positive photodynamic diagnosis, and positive intraoperative pathology were significant factors in improving the sampling accuracy. Navigation-guided endoscopic biopsy could provide a larger sample volume within a relatively short operation time. The biopsy can be easily combined with both photodynamic diagnosis and intraoperative pathology, significantly improving the histological diagnostic yield.

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“…The principle risk of a biopsy is hemorrhage. Mortality in most series is 1-2% and neurological morbidity 3-5% (6). Neurosurgical admission is stressful for the patients, as well as being costly, and histology is inconclusive in up to 8-12% of patients (6)(7)(8).…”

mentioning

confidence: 99%

Combined use of neuroradiology and ¹H‐MR spectroscopy may provide an intervention limiting diagnosis of glioblastoma multiforme

Fellows

Wright

Sibtain

et al. 2010

Magnetic Resonance Imaging

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Purpose To evaluate the accuracy of 1H‐MR spectroscopy (1H‐MRS) as an intervention limiting diagnostic tool for glioblastoma multiforme. GBM is the most common and aggressive primary brain tumor, with mean survival under a year. Oncological practice currently requires histopathological diagnosis before radiotherapy. Materials and Methods Eighty‐nine patients had clinical computed tomography (CT) and MR imaging and 1.5T SV SE 1H‐MRS with PRESS localization for neuroradiological diagnosis and tumor classification with spectroscopic and automated pattern recognition analysis (TE 30 ms, TR 2000 ms, spectral width 2500 Hz and 2048 data points, 128–256 signal averages were acquired, depending on voxel size (8 cm3 to 4 cm3). Eighteen patients from a cohort of 89 underwent stereotactic biopsy. Results The 18 stereotactic biopsies revealed 14 GBM, 2 grade II astrocytomas, 1 lymphoma, and 1 anaplastic astrocytoma. All 14 biopsied GBMs were diagnosed as GBM by a protocol combining an individual radiologist and an automated spectral pattern recognition program. Conclusion In patients undergoing stereotactic biopsy combined neuroradiological and spectroscopic evaluation diagnoses GBM with accuracy that could replace the need for biopsy. We do not advocate the replacement of biopsy in all patients; instead our data suggest a specific intervention limiting role for the use of 1H‐MRS in brain tumor diagnosis. J. Magn. Reson. Imaging 2010;32:1038–1044. © 2010 Wiley‐Liss, Inc.

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Stereotactic computed tomography–guided brain biopsy: diagnostic yield based on a series of 170 patients

Cited by 41 publications

References 33 publications

Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema

Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema

Navigation-Guided Endoscopic Biopsy for Intraparenchymal Brain Tumor

Combined use of neuroradiology and ¹H‐MR spectroscopy may provide an intervention limiting diagnosis of glioblastoma multiforme

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Stereotactic computed tomography–guided brain biopsy: diagnostic yield based on a series of 170 patients

Cited by 41 publications

References 33 publications

Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema

Quantitative apparent diffusion coefficients in the characterization of brain tumors and associated peritumoral edema

Navigation-Guided Endoscopic Biopsy for Intraparenchymal Brain Tumor

Combined use of neuroradiology and 1H‐MR spectroscopy may provide an intervention limiting diagnosis of glioblastoma multiforme

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Combined use of neuroradiology and ¹H‐MR spectroscopy may provide an intervention limiting diagnosis of glioblastoma multiforme