Feasibility, Risk Profile and Diagnostic Yield of Stereotactic Biopsy in Children and Young Adults with Brain Lesions

Abstract

Objective To evaluate the feasibility, safety, and diagnostic yield of stereotactic biopsy (SB) in children and adolescents with cerebral lesions.

Methods We performed a systematic review of the literature and a retrospective analysis of all pediatric and adolescent patients who underwent SB for unclear brain lesions at our center. We collected patient and lesion-associated parameters, analysed the rate of procedural complications and diagnostic yield.

Results Our institutional series consisted of 285 SBs in 269 children and young adults between 1989 and 2016 (median age, 9 (range 1–18) years). There was no procedure-related mortality. Permanent and transient morbidity was 0.7% and 5.8%, respectively. Lesions were located in brain lobes (26.3%) and in midline structures (73.7%). The diagnostic yield was 97.5% and histology consisted low-grade gliomas (44.2%), high-grade gliomas (15.1%), non-glial tumors (22.8%), and non-neoplastic disease (15.4%). Morbidity was not associated with tumor location, age, histology or intraoperative position of the patient. In order to compare our findings with previous reports, we reviewed 25 studies with 1 109 children and young adults which had underwent SB. The diagnostic yield ranged between 83% and 100%. The reported morbidity and mortality rates range from 0–27% and 0–3.3%, respectively.

Conclusions SB in this particular patient population is a safe and a high-yield diagnostic procedure and indicates therefore its importance in the light of personalized medicine with the development of individual molecular treatment strategies.

Zusammenfassung

Zielsetzung Evaluation der Durchführbarkeit, Sicherheit und der diagnostischen Ausbeute von stereotaktischen Biopsien (SB) bei Kindern und jungen Erwachsenen mit zerebralen Läsionen.

Methoden Wir analysierten retrospektiv an einem einzelnen universitären Zentrum alle pädiatrischen und jugendlichen Patienten, die aufgrund einer unklaren zerebralen Läsion stereotaktisch biopsiert wurden. Ergebnisse dieser Erhebung wurden mit Ergebnissen einer systematischen Literaturrechereche zu diesem Thema verglichen.

Ergebnisse Die retrospektive Analyse identifizierte 285 SBs, die bei 269 Patienten (medianes Alter 9 (Spanne 1–18) Jahre) zwischen 1989 und 2016 durchgeführt wurden. Die behandlungsassoziierte Mortatilität betrug 0%. Die permanente und transiente Morbidität lag bei 0,7 bzw. 5,8%. Die Lokalisation der Läsionen war lobär (26.3%) bzw. in Mittellinienstrukturen (73,7%). Die histologische Aufarbeitung war in 97,5% der Fälle erfolgreich und ergab in 44,2% niedriggradige Gliome, 15,1% hochgradige Gliome, 22,8% nicht-gliale Tumore und 15,4% nicht-neoplastische Prozesse. Die Morbidität war weder mit der Tumorlokalisation noch dem Alter, der Histologie oder der intraoperativen Position des Patienten assoziiert. Um unsere Ergebnisse mit früheren Studien zu vergleichen führten wir einen Review durch, in den wir 25 Studien mit 1 109 Kindern und jugendliche Patienten einschließen konnten, bei denen eine SB durchgeführt werden konnte. Der diagnostische Erfolg lag zwischen 83 und 100%. Die Morbidität- und Mortalitätsrate war mit 0–27% und 0–3.3% angegeben.

Schlussfolgerung Die SB in dieser Population ist eine sichere und mit hoher diagnostischer Ausbeute einhergehende Methode und unterstreicht dadurch seine Wichtigkeit insbesondere im Zuge der personalisierten Medizin mit individuellen Behandlungsstrategien.

Schlüsselwörter

stereotaktische Biopsie - pädiatrische Hirntumoren - Morbidität - diagnostische Ausbeute - Sicherheit

Key words

stereotactic biopsy - pediatric brain tumors - morbidity - diagnostic accuracy - safety

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