Pathology Techniques in Stereotactic and Image Guided Biopsy

Abstract

Stereotactic brain biopsy has become a standard and widely available technique in the past two decades for obtaining tissue from intracranial lesions. The success of the procedure is dependent on (1) the neurosurgeon obtaining a representative sample from the lesion and (2) the ability of the pathologist to make an accurate diagnosis. It has been well documented that stereotactic brain biopsy is a highly effective diagnostic procedure in major academic centers where neurosurgeons specialize in stereotactic procedures and special expertise in neuropathology is readily available. The reported non-diagnostic rate in major centers varies between 4 and 7.2% [1–6]. The incidence of diagnostic failure does not appear to depend on the computed tomographic (CT) morphology of the lesion or the experience of the surgeon [7]. The high level of accuracy is maintained even when results of biopsy are compared with subsequent resection [8]. With the increasing use of the procedure in community hospitals, the success of stereotactic biopsy at the present time depends, among other factors, on the ability of the community hospital’s pathologist to make a diagnosis [9]. The pathologist’s expertise in many such settings is limited by lack of specific training in stereotactic biopsies and the lack of experience working with the very small volumes of tissue available from stereotactic biopsies. It is critical to develop a technique for pathological processing of stereotactic biopsies that will utilize the strengths that community pathologists already have, so as to optimize diagnosis [4].