Stereotactic Biopsy in the Era of Advanced Neuroimaging. Does the Minimal Therapeutic Gain Justify its Current Wide Use?

Abstract

Objective: This study reviewed the contribution of stereotactic brain biopsy in the management and final outcome of a series of patients with presumed inoperable lesions.

Patients and Methods: Sixty-nine consecutive patients underwent a CT-guided lesion biopsy (n = 67) or abscess/cyst aspiration (n = 2) using the Cosman-Roberts-Wells (CRW) frame.

Results: A definitive specific diagnosis was made in 53 of 67 patients (79 %). The remaining procedures did not provide a diagnosis because of failure to obtain appropriate specimen (11 patients), findings consistent with non-specific inflammation (2 patients) or uneventful surgical complication requiring termination of the procedure (1 patient). A total of 55 patients (80 %) died due to the malignant nature of the lesion, most within six months after the biopsy. The preoperative imaging diagnosis was consistent with the histological diagnosis in 60 patients (87 % accuracy). The perioperative morbidity and mortality were nil and most of the patients were discharged within twenty-four hours.

Conclusions: The stereotactic biopsy did not alter either the therapeutic management or the mortality due to the natural course of the lesion. These findings indicate that the current principle of mandatory histological diagnosis in virtually all non-resectable brain lesions should be re-evaluated taking into account parameters such as: age, medical/neurological status, neuroimaging characteristics, patients' best interest and health care financial shortages.

Key words

Brain biopsy - stereotaxis - CT-guided biopsy

References

• 1 Fritsch M J, Leber M J, Gossett L, Lulu B A, Hamilton A J. Stereotactic biopsy of intracranial brain lesions: High diagnostic yield without increased complications: 65 consecutive biopsies with early postoperative scans.  Stereotactic Funct Neurosurg. 1998;  71/1 36-42
• 2 Krieger M D, Chandrasoma P T, Zee C S, Apuzzo M LJ. Role of stereotactic biopsy in the diagnosis and management of brain tumors.  Semin Surg Oncol. 1997;  14/1 13-25
• 3 Lee T, Kenny B, Hitchock E, Teddy P, Palividas H, Harkness W, Meyer C. Supratentorial masses: stereotactic or free hand biopsy?.  Br J Neurosurg. 1991;  5 331-338
• 4 Ranjan A, Rajshekhar V, Joseph T, Chandy M J, Chandi S M. Non-diagnostic CT-guided stereotactic biopsies in a series of 407 cases: influence of CT morphology and operator experience.  J Neurosurg. 1993;  79/6 839-844
• 5 Regis J, Bouillot P, Rouby-Volot F, Figarella-Branger A, Dufour H, Peragut J. Pineal region tumors and the role of stereotactic biopsy. Review of mortality, morbidity and diagnostic rates in 370 cases.  Neurosurg. 1996;  39 907-914
• 6 Revesz T, Scaravilli F, Coutinho L, Cockburn H, Sacares P, Thomas D GT. Reliability of histological diagnosis including grading in gliomas biopsied by image-guided stereotactic technique.  Brain. 1993;  116/4 781-793
• 7 Taratuto A L, Sevlever G, Piccardo P. Clues and pitfalls in stereotactic biopsy of the central nervous system.  Arch Pathol Lab Med. 1991;  115/6 596-602
• 8 Teck Mun Soo, Bernstein M, Provias J, Tasker R, Lozano A, Guha A. Failed stereotactic biopsy in a series of 518 cases.  Stereotactic Funct Neurosurg. 1995;  64/4 183-196
• 9 Thomas D, Nouby R. Experience in 300 case of CT-directed stereotactic surgery for lesion biosy and aspiration of hematoma.  Br J Neurosurg. 1989;  3 321-326
• 10 Voges J, Schroder R, Treuer H, Pastyr O, Schlegel W, Lorenz W J, Sturm V. CT-guided and computer assisted biopsy. Technique, results, indications.  Acta Neurochir. 1993;  125/1 - 4 142-149
• 11 Wilden J N, Kelly P J. CT computerized stereotactic biopsy for low density CT lesions presenting with epilepsy.  J Neurol Neurosurg Psychiatry. 1987;  50/10 1302-1305
• 12 Kondjiolka D, Lunsford L D, Martinez A J. Unreliability of conterporary neurodiagnostic imaging in evaluating suspected adult supratentorial low-grade astrocytoma.  J Neurosurg. 1993;  79/4 533-536
• 13 Kondjiolka D, Lunsford L D. The role of stereotactic biopsy in the management of gliomas.  J Neuro Onc. 1999;  42/3 205-213
• 14 Lunsford L D, Coffey R J, Cojocaru T, Leksell D. Image-guided stereotactic surgery: A 10-year evolutionary experience.  Stereotactic Funct Neurosurg. 1990;  54/55 375-387
• 15 Pell M, Thomas D. The initial experience with the CRW stereotactic system.  Br J Neurosurg. 1991;  5 123-128 / 1999; 42/3: 205 - 213
• 16 Chandrasoma P T, Smith M M, Apuzzo M LJ. Sterotactic biopsy in the diagnosis of brain masses: Comparison of result of biopsy and resected surgical specimen.  Neurosurgery. 1989;  24/2 160-165
• 17 Hall W A. The safety and efficacy of stereotactic biopsy for intracranial lesions.  Cancer. 1998;  82/9 1749-1755
• 18 Bernstein M, Parrent A G. Complications of CT-guided stereotactic biopsy of intra-axial brain lesions.  J Neurosurg. 1994;  81/2 165-168
• 19 Couldwell W T, Apuzzo M LJ. Initial experience related to the use of the Cosman-Roberts-Wells stereotactic instrument. Technical note.  J Neurosurg. 1990;  72/1 145-148
• 20 Davis D H, Kelly P J, Marsh W R, Kall B A, Goerss S J. Computer-assisted stereotactic biopsy of intracranial lesions.  Appl Neurophysiol. 1987;  50/1 172-177
• 21 Field M, Witham T F, Flickinger JC, Kondziolka D, Lunsford D. Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy.  J Neurosurg. 2001;  94 545-551
• 22 Friedman W A, Sceats J, Nestock B R, Ballinger W E, Lunsford D L. The incidence of unexpected pathological findings in an image-guided biopsy series: A review of 100 consecutive cases.  Neurosurgery. 1989;  25/2 180-184
• 23 Kelly P J, Earnest F, Kall B A. et al . Surgical options for patients with deep-seated brain tumors: Computer-assisted stereotactic biopsy.  Mayo Clin Proc. 1985;  60/4 223-229
• 24 Kulkarni A V, Guha A, Lozano A, Bernstein M. Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy.  J Neurosurg. 1998;  89/1 31-35