Is it Appropriate to Redefine the Indication for Stereotactic Brain Biopsy in the MRI Era? Correlation with Final Histological Diagnosis in Supratentorial Gliomas

Abstract

Background: The aim of this study was to evaluate the advisability of modifying the indications for stereotactic brain biopsy (SBB) in high- and low-grade supratentorial glial tumors in correlation with the diagnostic accuracy of magnetic resonance imaging (MRI).

Materials and Methods: We analyzed 174 cases of supratentorial glial lesions diagnosed by MRI before biopsy. On the basis of the MRI findings the patients were divided into two groups: high-grade (n=107) and low-grade (n=67) gliomas. All patients underwent CT-guided biopsy. Only one preoperative diagnosis was allowed.

Results: A final histological diagnosis was achieved in 95% of the 174 cases. In the group of high-grade gliomas (HGG) there was diagnostic coincidence in 87% of cases, reaching 100% in lesions of the corpus callosum. In 11 cases (10%) the histological analysis changed the presumptive diagnosis and the consequent management. In the group of low-grade gliomas (LGG) there was diagnostic coincidence in 63% (42 cases), whereas there was discordance in 30%: 10 cases were upgraded to anaplastic astrocytoma, and in 10 cases no tumors were observed at all.

Conclusions: In the future, the histological diagnosis of glial tumors will include molecular genetic definition, thus making it crucial for management using the new therapeutic options. Today, the indications for biopsy in lesions mimicking high-grade gliomas are mainly linked to the site of the tumor, coexisting differential diagnoses or more than one treatment option. In lesions of the corpus callosum, histological analysis seems not to be required in order to proceed to complementary therapies. On the contrary, in lesions where MRI findings indicate low-grade gliomas, grading is crucial also in order to avoid treatment inappropriate in non-neoplastic lesions.

Key words

stereotactic brain biopsy - glioma - astrocytoma - magnetic resonance imaging

References

• 1 Grant R. Overview: brain tumour diagnosis and management/Royal College of Physicians guidelines.  J Neurol Neurosurg Psychiatry. 2004;  75 ((suppl II)) 18-23
• 2 Guidelines and outcomes committee of AANS: . Practice parameters in adults with suspected or known supratentorial non-optic pathway low-grade glioma.  Neurosurg Focus. 1998;  4 , Article 10
• 3 Stranjalis G, Protopapa D, Sakas DE, Chondros D. Stereotactic biopsy in the era of advanced neuroimaging. Does the minimal therapeutic gain justify its current wide use?.  Minim Invas Neurosurg. 2003;  46 90-93
• 4 Vaquero J, Martinez R, Manrique M. Stereotactic biopsy for brain tumors: Is it always necessary?.  Surg Neurol. 2000;  53 432-438
• 5 Linskey ME. The changing role of stereotaxis in surgical neuro-oncology.  J Neurooncol. 2004;  69 35-54
• 6 Tilgner J, Herr M, Ostertag Cavil B. Validation of intraoperative diagnoses using smear preparations for stereotactic brain biopsies: Intraoperative versus final diagnosis - Influence of clinical factors.  Neurosurgery. 2005;  56 257-265
• 7 Kondziolka D, Lunsord LD. The role of stereotactic biopsy in the management of gliomas.  J Neurooncol. 1999;  42 205-213
• 8 Apuzzo MLJ, Chandrasoma PT, Cohen D, Zee CS, Zelman V. Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses.  Neurosurgery. 1987;  20 930-937
• 9 Kim JE, Kim DG, Paek DG, Jung HW. Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment.  Acta Neurochir. 2003;  145 547-555
• 10 Soo TM, Bernstein M, Provias J, Tasker R, Lozano A, Ghua A. Failed stereotactic biopsy in a series of 518 cases.  Stereotact Funct Neurosurg. 1966;  64 183-196
• 11 Angelis LM De. Brain tumors.  N Engl J Med. 2001;  344 114-119
• 12 Dal Pozzo G. Compendio di Risonanza Magnetica. , UTET, ed. 2001;  557-583
• 13 Keles GE, Kathleen R, Lamborn PD, Berger MS. Low-grade hemispheric gliomas in adult: a critical review of extent of resection as a factor influencing outcome.  J Neurosurg. 2001;  95 735-745
• 14 Nasir S, Angelis LM De. Update on management of primary CNS lymphoma.  Oncology. 2000;  14 228-234
• 15 Kondziolka D, Lunsord D, Martinez J. Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma.  J Neurosurg. 1993;  79 533-536
• 16 Muacevic A, Kreth FW. Der Stellenwert der stereotaktischen Hirnbiopsie fur das Management von Patienten mit supratentoriellen Gliomen WHO-Grad-II.  Nervenartz. 2003;  74 350-354
• 17 Chamberlain MC, Murovic JA, Levin VA. Absence of contrast enhancement on CT brain scans of patients with supratentorial malignant gliomas.  Neurology. 1988;  38 1371-1374
• 18 Engelhard HH. Current diagnosis and treatment of oligodendroglioma.  Neurosurg Focus. 2002;  12 ((2)) , Article 2
• 19 Mundinger F. CT stereotactic biopsy for optimizing the therapy of intracranial processes.  Acta Neurochir Suppl. 1985;  35 70-74
• 20 Ostertag CB. Reliability of stereotactic brain tumor biopsy. In: Lunsford, LD (ed). Modern stereotactic neurosurgery. Boston, Metrinus Nijhoff 1988: 129-196
• 21 Friedman WA, Sceats J, Nestock BR, Ballinger WA, Lunsford DL. The incidence of unexpected pathological findings in an image-guided biopsy series: A review of 100 consecutive cases.  Neurosurgery. 1989;  25 180-184
• 22 Arbit E, Galicich J. Importance of image guided stereotactic biopsy to confirm diagnosis in an oncological setting.  Ann Surg Oncol. 1994;  1 368-372
• 23 Hagen T, Nieder C, Moringlane JR, Feiden W, Koning J. Correlation of preoprerative neuroradiologic with postoperative histologic diagnosis in pathological intracranial processes.  Radiologe. 1995;  35 808-815
• 24 Hall WA. The safety and efficacy of stereotactic biopsy for intracranial lesions.  Cancer. 1998;  82 1749-1755
• 25 Chandrasoma PT, Smith MM, Apuzzo MLJ. Stereotactic biopsy in the diagnosis of brain masses: Comparison of results of biopsy and resected surgical specimen.  Neurosurgery. 1989;  24 160-164
• 26 Lopes MB, Laws ER. Low grade central nervous system tumours.  Neurosurg Focus. 2002;  12 ((2)) , Article 1, 1-4
• 27 Hegi ME. MGMT gene silencing and benefit from Temozolamide in glioblastoma.  New Engl J Med. 2005;  352 997-1003
• 28 Grunert P, Ungersbock K, Bohl J, Kitz K, Hopf N. Results of 200 stereotactic biopsies.  Neurosurg Rev. 1994;  17 59-66

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