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Open Access 01-11-2010 | Clinical Article

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

Authors: Ruben Dammers, Joost W. Schouten, Iain K. Haitsma, Arnaud J. P. E. Vincent, Johan M. Kros, Clemens M. F. Dirven

Published in: Acta Neurochirurgica | Issue 11/2010

Abstract

Background

Previously, 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.

Methods

One 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.

Results

Demographics 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.

Conclusions

The 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.

Air EL, Leach JL, Warnick RE, McPherson CM (2009) Comparing the risks of frameless stereotactic biopsy in eloquent and noneloquent regions of the brain: a retrospective review of 284 cases. J Neurosurg 111:820–824CrossRefPubMed

Aker FV, Hakan T, Karadereler S, Erkan M (2005) Accuracy and diagnostic yield of stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimens. Neuropathology 25:207–213CrossRefPubMed

Bhardwaj RD, Bernstein M (2002) Prospective feasibility study of outpatient stereotactic brain lesion biopsy. Neurosurgery 51:358–361CrossRefPubMed

Brainard JA, Prayson RA, Barnett GH (1997) Frozen section evaluation of stereotactic brain biopsies: diagnostic yield at the stereotactic target position in 188 cases. Arch Pathol Lab Med 121:481–484PubMed

Chen CC, Hsu PW, Erich Wu TW, Lee ST, Chang CN, Wei KC, Chuang CC, Wu CT, Lui TN, Hsu YH, Lin TK, Lee SC, Huang YC (2009) Stereotactic brain biopsy: single center retrospective analysis of complications. Clin Neurol Neurosurg 111:835–839CrossRefPubMed

Chernov MF, Muragaki Y, Ochiai T, Taira T, Ono Y, Usukura M, Maruyama T, Nakaya K, Nakamura R, Iseki H, Kubo O, Hori T, Takakura K (2009) Spectroscopy-supported frame-based image-guided stereotactic biopsy of parenchymal brain lesions: comparative evaluation of diagnostic yield and diagnostic accuracy. Clin Neurol Neurosurg 111:527–535CrossRefPubMed

Dammers R, Haitsma IK, Schouten JW, Kros JM, Avezaat CJ, Vincent AJ (2008) Safety and efficacy of frameless and frame-based intracranial biopsy techniques. Acta Neurochir (Wien) 150:23–29CrossRef

Dorward NL, Paleologos TS, Alberti O, Thomas DG (2002) The advantages of frameless stereotactic biopsy over frame-based biopsy. Br J Neurosurg 16:110–118CrossRefPubMed

Ferreira MP, Ferreira NP, Pereira Filho Ade A, Pereira Filho Gde A, Franciscatto AC (2006) Stereotactic computed tomography-guided brain biopsy: diagnostic yield based on a series of 170 patients. Surg Neurol 65(S1):27–32CrossRef

10.

Gralla J, Nimsky C, Buchfelder M, Fahlbusch R, Ganslandt O (2003) Frameless stereotactic brain biopsy procedures using the Stealth Station: indications, accuracy and results. Zentralbl Neurochir 64:166–170CrossRefPubMed

11.

Grossman R, Sadetzki S, Spiegelmann R, Ram Z (2005) Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies. Acta Neurochir (Wien) 147:627–631CrossRef

12.

Hall WA (1998) The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 82:1749–1755CrossRefPubMed

13.

Hemm S, Rigau V, Chevalier J, Picot MC, Bauchet L, El Fertit H, Rodriguez MA, Cif L, Vayssiere N, Zanca M, Baldet P, Segnarbieux F, Coubes P (2005) Stereotactic coregistration of 201Tl SPECT and MRI applied to brain tumor biopsies. J Nucl Med 46:1151–1157PubMed

14.

Heper AO, Erden E, Savas A, Ceyhan K, Erden I, Akyar S, Kanpolat Y (2005) An analysis of stereotactic biopsy of brain tumors and nonneoplastic lesions: a prospective clinicopathologic study. Surg Neurol 64(Suppl 2):S82–S88CrossRefPubMed

15.

Hermann EJ, Hattingen E, Krauss JK, Marquardt G, Pilatus U, Franz K, Setzer M, Gasser T, Tews DS, Zanella FE, Seifert V, Lanfermann H (2008) Stereotactic biopsy in gliomas guided by 3-tesla 1H-chemical-shift imaging of choline. Stereotact Funct Neurosurg 86:300–307CrossRefPubMed

16.

Kaakaji W, Barnett GH, Bernhard D, Warbel A, Valaitis K, Stamp S (2001) Clinical and economic consequences of early discharge of patients following supratentorial stereotactic brain biopsy. J Neurosurg 94:892–898CrossRefPubMed

17.

Kim JE, Kim DG, Paek SH, Jung HW (2003) Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment. Acta Neurochir (Wien) 145:547–554CrossRef

18.

Kongkham PN, Knifed E, Tamber MS, Bernstein M (2008) Complications in 622 cases of frame-based stereotactic biopsy, a decreasing procedure. Can J Neurol Sci 35:79–84PubMed

19.

Krieger MD, Chandrasoma PT, Zee CS, Apuzzo ML (1998) Role of stereotactic biopsy in the diagnosis and management of brain tumors. Semin Surg Oncol 14:13–25CrossRefPubMed

20.

Kuhn SA, Romeike B, Walter J, Kalff R, Reichart R (2009) Multiplanar MRI-CT fusion neuronavigation-guided serial stereotactic biopsy of human brain tumors: proof of a strong correlation between tumor imaging and histopathology by a new technical approach. J Cancer Res Clin Oncol 135:1293–1302CrossRefPubMed

21.

Landriel F, Hem S, Hasdeu S, Kitroser M, Peña L, Ajler P, Ciraolo C, Knezevich F (2008) Biopsia estereotáctica cerebral guiada tomográficamente análisis de una serie de 192 casos. Rev Argent Neuroc 22:110–113

22.

Levivier M, Goldman S, Pirotte B, Brucher JM, Baleriaux D, Luxen A, Hildebrand J, Brotchi J (1995) Diagnostic yield of stereotactic brain biopsy guided by positron emission tomography with [18F]fluorodeoxyglucose. J Neurosurg 82:445–452CrossRefPubMed

23.

Lunsford LD, Niranjan A, Khan AA, Kondziolka D (2008) Establishing a benchmark for complications using frame-based stereotactic surgery. Stereotact Funct Neurosurg 86:278–287CrossRefPubMed

24.

Maia AC Jr, Malheiros SM, da Rocha AJ, Stavale JN, Guimaraes IF, Borges LR, Santos AJ, da Silva CJ, de Melo JG, Lanzoni OP, Gabbai AA, Ferraz FA (2004) Stereotactic biopsy guidance in adults with supratentorial nonenhancing gliomas: role of perfusion-weighted magnetic resonance imaging. J Neurosurg 101:970–976CrossRefPubMed

25.

McDermott MW, Bernstein M (2008) Image-guided surgery. In: Bernstein M, Berger MS (eds) Neuro-oncology: the essentials. Thieme Medical Publishers, Inc, New York, pp 112–125

26.

McGirt MJ, Woodworth GF, Coon AL, Frazier JM, Amundson E, Garonzik I, Olivi A, Weingart JD (2005) Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases. J Neurosurg 102:897–901CrossRefPubMed

27.

Mosskin M, Ericson K, Hindmarsh T, von Holst H, Collins VP, Bergstrom M, Eriksson L, Johnstrom P (1989) Positron emission tomography compared with magnetic resonance imaging and computed tomography in supratentorial gliomas using multiple stereotactic biopsies as reference. Acta Radiol 30:225–232CrossRefPubMed

28.

Muragaki Y, Chernov M, Maruyama T, Ochiai T, Taira T, Kubo O, Nakamura R, Iseki H, Hori T, Takakura K (2008) Low-grade glioma on stereotactic biopsy: how often is the diagnosis accurate? Minim Invasive Neurosurg 51:275–279CrossRefPubMed

29.

O'Neill KS, Dyer PV, Bell BA, Wilkins PR, Uttley D, Marsh HT (1992) Is peroperative smear cytology necessary for CT-guided stereotaxic biopsy? Br J Neurosurg 6:421–427CrossRefPubMed

30.

Owen CM, Linskey ME (2009) Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle. J Neurooncol 93:139–149CrossRefPubMed

31.

Paleologos TS, Dorward NL, Wadley JP, Thomas DG (2001) Clinical validation of true frameless stereotactic biopsy: analysis of the first 125 consecutive cases. Neurosurgery 49:830–835CrossRefPubMed

32.

Pirotte B, Goldman S, Massager N, David P, Wikler D, Vandesteene A, Salmon I, Brotchi J, Levivier M (2004) Comparison of 18F-FDG and 11C-methionine for PET-guided stereotactic brain biopsy of gliomas. J Nucl Med 45:1293–1298PubMed

33.

Pirotte BJ, Lubansu A, Massager N, Wikler D, Goldman S, Levivier M (2007) Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors. J Neurosurg 107:392–399CrossRefPubMed

34.

Shastri-Hurst N, Tsegaye M, Robson DK, Lowe JS, Macarthur DC (2006) Stereotactic brain biopsy: an audit of sampling reliability in a clinical case series. Br J Neurosurg 20:222–226CrossRefPubMed

35.

Shooman D, Belli A, Grundy PL (2010) Image-guided frameless stereotactic biopsy without intraoperative neuropathological examination. J Neurosurg. doi:10.3171/2009.12.JNS09573

36.

Smith JS, Quinones-Hinojosa A, Barbaro NM, McDermott MW (2005) Frame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy. J Neurooncol 73:173–179CrossRefPubMed

37.

Teixeira MJ, Fonoff ET, Mandel M, Alves HL, Rosemberg S (2009) Stereotactic biopsies of brain lesions. Arq Neuropsiquiatr 67:74–77PubMed

38.

Tilgner J, Herr M, Ostertag C, Volk B (2005) Validation of intraoperative diagnoses using smear preparations from stereotactic brain biopsies: intraoperative versus final diagnosis–influence of clinical factors. Neurosurgery 56:257–265CrossRefPubMed

39.

Ulm AJ, Bova FJ, Friedman WA (2001) Stereotactic biopsy aided by a computer graphics workstation: experience with 200 consecutive cases. Surg Neurol 56:366–371CrossRefPubMed

40.

Woodworth G, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD (2005) Accuracy of frameless and frame-based image-guided stereotactic brain biopsy in the diagnosis of glioma: comparison of biopsy and open resection specimen. Neurol Res 27:358–362CrossRefPubMed

41.

Woodworth GF, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD (2006) Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique. J Neurosurg 104:233–237CrossRefPubMed

Title: Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre
Authors: Ruben Dammers
Joost W. Schouten
Iain K. Haitsma
Arnaud J. P. E. Vincent
Johan M. Kros
Clemens M. F. Dirven
Publication date: 01-11-2010
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 11/2010
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-010-0752-0

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Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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