Factors affecting diagnostic yield in stereotactic biopsy for brain lesions: a 5-year single-center series

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.

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Frame-Based CT-Guided Stereotactic Biopsy in Treatment of Different Brain Lesions

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0035-1566377 ◽

2015 ◽

Vol 76 (S 02) ◽

Author(s):

Bojan Jelača ◽

Petar Vuleković ◽

Vladimir Papić ◽

Mladen Karan ◽

Tomislav Cigić ◽

...

Keyword(s):

Stereotactic Biopsy ◽

Brain Lesions ◽

Ct Guided

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Related factors with diagnostic yield and intracranial hemorrhagic complications in frame-based stereotactic biopsy. Review

Neurocirugía (English Edition) ◽

10.1016/j.neucie.2021.04.004 ◽

2021 ◽

Author(s):

Mónica Lara-Almunia ◽

Javier Hernández-Vicente

Keyword(s):

Stereotactic Biopsy ◽

Diagnostic Yield ◽

Related Factors ◽

Hemorrhagic Complications

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DIPG-35. BIOLOGICAL MEDICINE FOR DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG) ERADICATION: RESULTS OF THE THREE ARM BIOMARKER-DRIVEN RANDOMIZED BIOMEDE 1.0 TRIAL

Neuro-Oncology ◽

10.1093/neuonc/noaa222.083 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii293-iii294

Author(s):

Jacques Grill ◽

Gwenael Le Teuff ◽

Karsten Nysom ◽

Klas Blomgren ◽

Darren Hargrave ◽

...

Keyword(s):

Disease Progression ◽

Stereotactic Biopsy ◽

Diagnostic Yield ◽

Steering Committee ◽

Diffuse Intrinsic Pontine Glioma ◽

Open Label ◽

Pten Loss ◽

Multi Stage ◽

Open Label Phase ◽

Biological Medicine

Abstract Despite 50 years of clinical trials, no improvement of survival has been observed in DIPG and most children die within 2 years of diagnosis. Only radiotherapy transiently controls disease progression. The study was conceived as a randomized multi-arm multi-stage program. It started with an open-label phase-II trial comparing three drugs (everolimus, dasatinib, erlotinib) combined with irradiation, allocated according to the presence of their specific targets (PTEN-loss, EGFR-overexpression) defined with a stereotactic biopsy after central confirmation of the diagnosis (presence of histone H3K27M mutation or loss of K27 trimethylation). Targeted therapies were started concomitantly with radiotherapy and were continued until disease progression. No biopsy-related death was reported and diagnostic yield was excellent, with only 5 non-informative biopsies. Biopsy excluded the diagnosisof DIPG in 8% of the cases. At the 3rd interim analysis, based on 193 randomized patients, the IDMC concluded that the study was unlikely to show a difference of OS between the 3 drugs even if 250 patients would be randomized. The median OS from the time of diagnosis was 11.9, 10.5 and 10 months for everolimus, dasatinib and erlotinib. Treatment was discontinued due to toxicity in 2%, 13%, and 15%, respectively. BIOMEDE shows the feasibility of biologically-driven treatment in DIPG on a large international scale. Based on the better toxicity profile and the slightly better efficacy, although not statistically significant, the steering committee proposed that everolimus should be used as the control arm for the next BIOMEDE 2.0 trial.

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Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique

Journal of Neurosurgery ◽

10.3171/jns.2006.104.2.233 ◽

2006 ◽

Vol 104 (2) ◽

pp. 233-237 ◽

Cited By ~ 132

Author(s):

Graeme F. Woodworth ◽

Matthew J. McGirt ◽

Amer Samdani ◽

Ira Garonzik ◽

Alessandro Olivi ◽

...

Keyword(s):

Stereotactic Biopsy ◽

Diagnostic Yield ◽

Brain Biopsy ◽

Morbidity Rate ◽

Frameless Stereotaxy ◽

Cortical Lesions ◽

Stereotactic Brain Biopsy ◽

Biopsy Procedure ◽

Image Guided ◽

Permanent Morbidity

Object The gold standard for stereotactic brain biopsy target localization has been frame-based stereotaxy. Recently, frameless stereotactic techniques have become increasingly utilized. Few authors have evaluated this procedure, analyzed preoperative predictors of diagnostic yield, or explored the differences in diagnostic yield and morbidity rate between the frameless and frame-based techniques. Methods A consecutive series of 110 frameless and 160 frame-based image-guided stereotactic biopsy procedures was reviewed. Associated variables for both techniques were reviewed and compared. All stereotactic biopsy procedures were included in a risk factor analysis of nondiagnostic biopsy sampling. Frameless stereotaxy led to a diagnostic yield of 89%, with a total permanent morbidity rate of 6% and a mortality rate of 1%. Larger lesions were fivefold more likely to yield diagnostic tissues. Deep-seated lesions were 2.7-fold less likely to yield diagnostic tissues compared with cortical lesions. Frameless compared with frame-based stereotactic biopsy procedures showed no significant differences in diagnostic yield or transient or permanent morbidity. For cortical lesions, more than one needle trajectory was required more frequently to obtain diagnostic tissues with frame-based as opposed to frameless stereotaxy, although this factor was not associated with morbidity. Conclusions With regard to diagnostic yield and complication rate, the frameless stereotactic biopsy procedure was found to be comparable to or better than the frame-based method. Smaller and deep-seated lesions together were risk factors for a nondiagnostic tissue yield. Frameless stereotaxy may represent a more efficient means of obtaining biopsy specimens of cortical lesions but is otherwise similar to the frame-based technique.

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Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Journal of Neurosurgery ◽

10.3171/2014.9.jns14107 ◽

2015 ◽

Vol 122 (2) ◽

pp. 342-352 ◽

Cited By ~ 49

Author(s):

Michel Lefranc ◽

Cyrille Capel ◽

Anne-Sophie Pruvot-Occean ◽

Anthony Fichten ◽

Christine Desenclos ◽

...

Keyword(s):

Stereotactic Biopsy ◽

Clinical Symptoms ◽

Diagnostic Yield ◽

Ct Scanning ◽

Fiducial Marker ◽

Surface Registration ◽

Histological Diagnosis ◽

Consecutive Series ◽

Mortality And Morbidity ◽

Stereotactic Biopsies

OBJECT Stereotactic biopsy procedures are an everyday part of neurosurgery. The procedure provides an accurate histological diagnosis with the least possible morbidity. Robotic stereotactic biopsy needs to be an accurate, safe, frameless, and rapid technique. This article reports the clinical results of a series of 100 frameless robotic biopsies using a Medtech ROSA device. METHODS The authors retrospectively analyzed their first 100 frameless stereotactic biopsies performed with the robotic ROSA device: 84 biopsies were performed by frameless robotic surface registration, 7 were performed by robotic bone fiducial marker registration, and 9 were performed by scalp fiducial marker registration. Intraoperative flat-panel CT scanning was performed concomitantly in 25 cases. The operative details of the robotic biopsies, the diagnostic yield, and mortality and morbidity data observed in this series are reported. RESULTS A histological diagnosis was established in 97 patients. No deaths or permanent morbidity related to surgery were observed. Six patients experienced transient neurological worsening. Six cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were associated with transient clinical symptoms in only 2 cases. Stereotactic surgery was performed with patients in the supine position in 93 cases and in the prone position in 7 cases. The use of fiducial markers was reserved for posterior fossa biopsy via a transcerebellar approach, via an occipital approach, or for pediatric biopsy. CONCLUSIONS ROSA frameless stereotactic biopsies appear to be accurate and safe robotized frameless procedures.

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