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

2021 ◽  
Author(s):  
Mónica Lara-Almunia ◽  
Javier Hernández-Vicente
Keyword(s):  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Related Factors ◽  
Hemorrhagic Complications

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

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.

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

2006 ◽  
Vol 104 (2) ◽  
pp. 233-237 ◽  
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.

scholarly journals Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

2015 ◽  
Vol 122 (2) ◽  
pp. 342-352 ◽  
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.

scholarly journals Frame-based Stereotactic Biopsy: Description and Association of Anatomical, Radiologic, and Surgical Variables with Diagnostic Yield in a Series of 407 Cases

2019 ◽  
Vol 80 (03) ◽  
pp. 149-161 ◽  
Author(s):  
Monica Lara-Almunia ◽  
Javier Hernandez-Vicente
Keyword(s):  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Invasive Technique ◽  
Histologic Diagnosis ◽  
Stereotactic Techniques ◽  
Cystic Component ◽  
Intracranial Lesions ◽  
Spss Software ◽  
Improved Accuracy ◽  
Extensive Necrosis

Background and Study Aims Stereotactic biopsy is a versatile, minimally invasive technique to obtain tissue safely from intracranial lesions for their histologic diagnosis and therapeutic management. Our objective was to determine the anatomical, radiologic, and technical factors that can affect the diagnostic yield of this technique. We suggest recommendations to improve its use in clinical practice. Methods This retrospective study evaluated 407 patients who underwent stereotactic biopsies in the past 34 years. The surgical methodology changed through time, distinguished by three distinct periods. Different stereotactic frames (Todd-Wells, CRW, Leksell), neuroimaging tests, and planning programs were used. Using SPSS software v.23, we analyzed a total of 50 variables for each case. Results The series included 265 men (65.1%) and 142 women (34.9%) (average age 53.8 years). The diagnostic yield was 90.4%, morbidity was 5.65% (n = 17), and mortality was 0.98% (n = 4). Intraoperative biopsy improved accuracy (p = 0.024). Biopsies of deep lesions (p = 0.043), without contrast enhancement (p = 0.004), edema (p = 0.036), extensive necrosis (p = 0.028), or a large cystic component (p = 0.023) resulted in a worse diagnostic yield. Neurosurgeons inexperienced in stereotactic techniques obtained more nondiagnostic biopsies (p = 0.043). Experience was the clearest predictive factor of diagnostic yield (odds ratio: 4.049). Conclusions Increased experience in stereotactic techniques, use of the most suitable magnetic resonance imaging sequences during biopsy planning, and intraoperative evaluation of the sample before finalizing the collection are recommended features and ways to improve the diagnostic yield of this technique.

IMPACT OF BRAIN BIOPSY ON THE MANAGEMENT OF PATIENTS WITH NONNEOPLASTIC UNDIAGNOSED NEUROLOGICAL DISORDERS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 833-838 ◽  
Author(s):  
Heinke Pulhorn ◽  
D. Gavin Quigley ◽  
Jark J.D. Bosma ◽  
Ramez Kirollos ◽  
Daniel G. du Plessis ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Diagnostic Category ◽  
Brain Biopsy ◽  
Clinical Impact ◽  
Complication Rates ◽  
Open Biopsy ◽  
Retrospective Case ◽  
Stereotactic Brain Biopsy

Abstract OBJECTIVE We sought to assess the diagnostic yield, complication rates, and therapeutic impact of open brain biopsy and serial stereotactic brain biopsy in the management of patients with nonneoplastic neurological conditions in which conventional investigations did not yield a definitive diagnosis. METHODS A retrospective case note analysis was undertaken in consecutive patients undergoing brain biopsy at The Walton Centre for Neurology and Neurosurgery during a 15-year period. The diagnostic yield, prebiopsy diagnostic category, biopsy technique (open versus stereotactic), complication rates, and impact on clinical management were assessed. Biopsies were grouped into one of five categories: diagnostic, suggestive, nonspecific, normal, or nondiagnostic. RESULTS Thirty-nine patients underwent biopsy. The diagnostic yield (combined diagnostic and suggestive) of targeted serial stereotactic biopsy was 64% (seven of 11 patients); in the open brain biopsy group, the diagnostic yield was 46% (13 of 28 patients). The prebiopsy diagnosis was confirmed in 100% (three of three patients) stereotactic biopsy patients and 75% (nine of 12 patients) of open biopsy patients. Two patients (7%) in the open biopsy group had short-term complications. The clinical impact was similar in both groups: nine of 28 (32%) open biopsy patients and four of 11 (36%) stereotactic biopsy patients. CONCLUSION Despite the low clinical impact, diagnostic brain biopsy should be considered in patients with nonneoplastic undiagnosed neurological disorders. Patients with neuroimaging abnormalities should preferentially undergo targeted biopsy.

Combined magnetic resonance imaging– and positron emission tomography–guided stereotactic biopsy in brainstem mass lesions: diagnostic yield in a series of 30 patients

2000 ◽  
Vol 8 (2) ◽  
pp. 1-6 ◽  
Author(s):  
Nicolas Massager ◽  
Philippe David ◽  
Serge Goldman ◽  
Benoît Pirotte ◽  
David Wikler ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Emission Tomography ◽  
Mass Lesion ◽  
Resonance Imaging ◽  
Positron Emission ◽  
Mass Lesions

In the management of brainstem lesions, the place of stereotactic biopsy sampling remains debatable. The authors compared the results of magnetic resonance (MR) imaging, positron emission tomography (PET), and histological findings obtained in 30 patients who underwent an MR image– and PET-guided stereotactic biopsy procedure for a brainstem mass lesion. Between July 1991 and December 1998, 30 patients harboring a brainstem mass lesion underwent a stereotactic procedure in which combined MR imaging and PET guidance was used. Positron emission tomography scanning was performed using [18F]-fluorodeoxyglucose in 16 patients, methionine in two patients, and with both tracers in 12 patients. Definite diagnosis was established on histological examination of the biopsy samples. Interpretation of MR imaging findings only or PET findings only were in agreement with the histological diagnosis in 63% and 73% of cases, respectively. Magnetic resonance imaging and PET findings were concordant in 19 of the 30 cases; in those cases, imaging data correlated with histological findings in 79%. In seven patients who underwent one PET-defined and one MR imaging–defined trajectory, at histological examination the PET-guided samples were more representative of the tumor's nature and grade than the MR imaging–guided samples in four cases (57%). In 18 patients PET scanning was used to define a biopsy target and provided a diagnostic yield in 100% of the cases. Although the use of combined PET and MR imaging improves radiological interpretation of a mass lesion in the brainstem, it does not accurately replace histological diagnosis that is provided by a stereotactically obtained biopsy sample. Combined information provided by MR imaging and PET in stereotactic conditions improves the accuracy of targeting and the diagnostic yield of the stereotactically biopsy sample; an MR imaging– and PET-guided stereotactic biopsy procedure is a safe and efficient modality for the management of mass lesions of the brainstem.

Clinical Validation of True Frameless Stereotactic Biopsy: Analysis of the First 125 Consecutive Cases

Neurosurgery ◽  
2001 ◽  
Vol 49 (4) ◽  
pp. 830-837 ◽  
Author(s):  
Theophilos S. Paleologos ◽  
Neil L. Dorward ◽  
John P. Wadley ◽  
David G.T. Thomas
Keyword(s):  
Operative Time ◽  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Target Selection ◽  
Guidance System ◽  
Morbidity Rate ◽  
Clinical Validation ◽  
Stereotactic Technique ◽  
The Mean ◽  
Stereotactic Biopsies

Abstract OBJECTIVE A lockable guide device, adjustable for positioning, was used to obtain samples for tissue analysis during brain biopsy procedures performed using an interactive image guidance system. Clinical validation of this technique, which was developed for true frameless stereotactic biopsies, and analyses of the histological yield, complication rate, and patient demographic characteristics for a large series of frameless stereotactic biopsies were the purposes of this study. METHODS Demographic, radiological, surgical, and clinical data were prospectively collected for a series of 125 frameless stereotactic biopsies performed using the technique described in detail previously. RESULTS Eighty-six procedures were magnetic resonance imaging-directed and 39 were computed tomography-directed. The mean diameter of the biopsied lesions was 36 mm, and the mean distance from the skin was 35.8 mm. Sixteen percent of the patients harbored multiple lesions, and 5.6% of the biopsied lesions were infratentorial. The mean operative time (including the entire anesthetic time) was 1.5 hours. The smear examination findings were corroborated by conclusive histological results in 96% of the cases, and definitive positive diagnoses were obtained in 122 cases (97.6%). Ten patients experienced surgical complications, but the sustained morbidity rate was 2.4% (including the death of a patient who was in critical clinical condition preoperatively and who died 2 mo later as a result of a chest infection; mortality rate, 0.8%). CONCLUSION This true frameless stereotactic biopsy technique was associated with low morbidity and mortality rates and an excellent diagnostic yield, with overall results at least as good as those observed for frame-based stereotaxy. The excellent accuracy results demonstrated previously and statistically significant reductions in operative time, as well as improved image presentation, target selection, and simplicity, support the use of this frameless stereotactic technique in preference to frame-based biopsy techniques.

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