Increasing the diagnostic yield of stereotactic brain biopsy using intraoperative histological smear

Abstract

ObjectiveThe negative biopsy rate approaches 5% in the literature. In our institution, this rate was 2.6% (42/1638) over a ten-year period (2007–2016). We aimed to assess the diagnostic yield of intraoperative smear during stereotactic biopsies to reduce this negative biopsy rate. Patients and methodsWe retrospectively analyzed all consecutive MRI-guided frame-based stereotactic biopsies for which an intraoperative histological smear was carried out, performed over 29 months from January 2017 to May 2019 at the Pitié-Salpêtrière University Hospital (Paris, France). Results145 stereotactic biopsies for which an intraoperative histological smear was carried out were performed in 145 adult patients. Mean age at biopsy was 52.4 ± 12.2 years. Histological diagnoses encountered in this series were: primary or secondary cerebral neoplasm (90.3%), inflammatory diseases (4.8%) and infectious diseases (4.8%). All biopsies were contributory to diagnosis. The negative biopsy rate was therefore significantly lower in the patient group for which an intraoperative histological smear was carried out than in our historical control group (0% versus 2.6%, p = 0.04). ConclusionConsidering the diagnostic yield benefit contributed by the intraoperative histological smear, we advocate for its routine use during brain stereotactic biopsies.