Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre

Abstract

BackgroundPreviously, we reported on our single centre results regarding the diagnostic yield of stereotactic needle biopsies of brain lesions. The yield then (1996–2006) was 89.4%. In the present study, we review and evaluate our experience with intraoperative frozen-section histopathologic diagnosis on-demand in order to improve the diagnostic yield.MethodsOne hundred sixty-four consecutive frameless biopsy procedures in 160 patients (group 1, 2006–2010) were compared with the historic control group (group 2, n = 164 frameless biopsy procedures). Diagnostic yield, as well as demographics, morbidity and mortality, was compared. Statistical analysis was performed by Student's t, Mann–Whitney U, Chi-square test and backward logistic regression when appropriate.ResultsDemographics were comparable. In group 1, a non-diagnostic tissue specimen was obtained in 1.8%, compared to 11.0% in group 2 (p = 0.001). Also, both the operating time and the number of biopsies needed were decreased significantly. Procedure-related mortality decreased from 3.7% to 0.6% (p = 0.121). Multivariate analysis only proved operating time (odds ratio (OR), 1.012; 95% confidence interval (CI), 1.000–1.025; p = 0.043), a right-sided lesion (OR, 3.183; 95% CI, 1.217–8.322; p = 0.018) and on-demand intraoperative histology (OR, 0.175; 95% CI, 0.050–0.618; p = 0.007) important factors predicting non-diagnostic biopsies.ConclusionsThe importance of a reliable pathological diagnosis as obtained by biopsy must not be underestimated. We believe that when performing stereotactic biopsy for intracranial lesions, next to minimising morbidity, one should strive for as high a positive yield as possible. In the present single centre retrospective series, we have shown that using a standardised procedure and careful on-demand intraoperative frozen-section analysis can improve the diagnostic yield of stereotactic brain biopsy procedures as compared to a historical series.

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

“…Stereotactic biopsy (SB) has been one of the techniques to make a diagnosis, which ensures the implementation of appropriate treatment modality in brain lesions especially after the use of CT (2,4,(7)(8)(9)(11)(12)(13)15,16,18,19,21,22,25,26,28,29,(31)(32)(33)(34)(35)(36)(37)(38). It is a reliable and safe diagnostic method which is preferred especially in deeply placed, widespread and multiple lesions.…”

“…Adaptation of PET, MR perfusion and MR spectroscopy (MRS) examinations to the planning of stereotactic biopsy procedures is significant in the determination of access to the target and the selection of appropriate target and plays a crucial role in increasing the diagnostic success and decreasing the sampling errors (10,12,26,30,36). The success rate is reported to be 100% in the latest studies in which patient numbers are relatively low (12).…”

“…The success rate is reported to be 100% in the latest studies in which patient numbers are relatively low (12). Furthermore, the use of metabolite scanning findings obtained in MRS examinations and specifically the rates of N-acetyl aspartate (NAA) and choline (Ch) increase the diagnostic success of the surgery by playing a role in the selection of a target location (10-12).…”

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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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“…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).…”