Abstract
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.
Highlights
Stereotactic biopsy techniques have been widely used since the 1940s and have become an important neurosurgical tool in the diagnosis of intracranial lesions [11]
We aimed to analyze all cases requiring a stereotactic biopsy at our department regarding diagnostic yield and the underlying etiology of the lesion, paying special attention to factors associated with non-diagnostic biopsies and discuss the outcome and clinical management of those patients
Most patients presented with motor deficits (35.4%, 110/ 311) or cognitive deficits (27.3%, 85/311); in the majority of cases (43.5%, 131/301), symptom onset was more than 1 month prior to presenting to our department
Summary
Stereotactic biopsy techniques have been widely used since the 1940s and have become an important neurosurgical tool in the diagnosis of intracranial lesions [11]. Apart from primary and secondary brain tumors, lesions can be of inflammatory, infectious, of autoimmune or vascular etiology. We aimed to analyze all cases requiring a stereotactic biopsy at our department regarding diagnostic yield and the underlying etiology of the lesion, paying special attention to factors associated with non-diagnostic biopsies and discuss the outcome and clinical management of those patients
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