P11.07.B What is the role of brain biopsy in the diagnosis of brain lesions?

Abstract

Abstract Background Brain biopsies have a role in establishing histological diagnoses for intrinsic tumours not amenable to surgical resection or lesions with an uncertain radiological diagnosis. Despite their utility, they are associated with several risks, particularly surgical complications and non-diagnostic samples. On this background, this study sought to determine the diagnostic yield and outcomes of brain biopsies carried out in a tertiary centre and explore factors which could influence the overall success of such procedures. Material and Methods All non-endoscopic brain biopsy procedures performed over a 1-year period (01/04/2020 to 01/04/2021) at one of the largest neurosurgical units in the UK were included. Hospital electronic records were used to identify eligible patients and determine relevant patient, procedure and outcome data. Mortality data were obtained with a minimum follow-up period of 1 year. Results A total of 75 cases were identified, including 55 burr hole biopsies and 20 open procedures. Overall, 16 (21%) biopsies were non-diagnostic, including 25% of burr hole biopsies and 10% of open biopsies. Procedures performed by a consultant had a lower non-diagnostic rate (17%) than cases with no consultant involvement (27%). Suspected inflammatory conditions had a higher non-diagnostic rate (55%) than suspected tumours (11%). Excluding non-diagnostic cases, histological diagnosis was in line with suspected pre-operative diagnosis in 70% of cases. Post-operative complications included 3 symptomatic haematomas and 1 subdural empyema, which led to one post-operative death. A total of 40 (55%) patients died within the follow-up period, including 10 (13%) within 60 days of their procedure. Six-month and 1 year survival rates were 35% and 26% for glioblastoma, respectively, and 70% and 70% for lymphoma. The majority (68%) of patients with a performance status (PS) of 3 or 4 prior to surgery died within 1 year, as compared to 42% with a PS of 0-2. Conclusion Brain biopsies are an important adjunct to managing CNS lesions due to the limitations of a radiological diagnosis alone. The diagnostic yield was greater for suspected neoplastic lesions, in cases with consultant involvement, and with open procedures.