Open AccessEvaluation of 311 contemporary cases of stereotactic biopsies in patients with neoplastic and non-neoplastic lesions—diagnostic yield and management of non-diagnostic cases
Author(s) -
Krystyna Agnieszka Pasternak,
Michael Schwake,
Nils Warneke,
Max Masthoff,
Samer Zawy Alsofy,
Eric Suero Molina,
Walter Stummer,
Stephanie Schipmann
Publication year - 2020
Publication title -
neurosurgical review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.063
H-Index - 60
eISSN - 1437-2320
pISSN - 0344-5607
DOI - 10.1007/s10143-020-01394-0
Subject(s) - medicine , biopsy , stereotactic biopsy , radiology , diagnostic accuracy , lesion , neurosurgery , retrospective cohort study , surgery
Stereotactic biopsies are an established tool for obtaining diagnosis of unclear brain lesions. However, non-diagnostic biopsies still occur. We aimed to analyze the contemporary diagnostic yield of stereotactic biopsies, predictors for non-diagnostic biopsies, outcome, and follow-up strategy after non-diagnostic biopsy. We conducted a single-center retrospective study of 311 adult patients undergoing stereotactic biopsies due to a newly diagnosed lesion at our department between 2012 and 2018. Patient data regarding comorbidities, presenting symptoms, imaging features, and non-invasive diagnostic procedures were obtained. The overall diagnostic yield was 86.2% and differed significantly between the various suspected diagnosis groups and was the highest when suspecting primary brain tumor compared with non-neoplastic lesions (91.2% vs. 73.3%, p > 0.001). Predicators for non-diagnostic biopsies were small lesion size, lack of contrast-enhancement, presence of sepsis, or underlying hemato-oncological disease. In case of non-diagnostic biopsy, a re-biopsy was performed in 12 cases, revealing a final diagnosis in 75%. In 16 cases, empiric therapy was started based on the suspected underlying disease. Close follow-up was performed in the remaining 15 cases. We showed that stereotactic biopsy is a safe procedure with reasonable diagnostic yield even for non-neoplastic lesions, when non-invasive diagnostic was inconclusive. In addition, we developed treatment recommendations for cases of non-diagnostic biopsies.