Stereotactic Brain Biopsies in AIDS Patients: Superior Diagnostic Yield with Side-Cutting Needle than with Cup Forceps

Abstract

Controversy still exists over the indicators for, and usefulness of, performing brain biopsies in AIDS patients with focal cerebral lesions. One of the sources of doubt is the relatively poor diagnostic yield in biopsying lesions in AIDS patients compared with patients who do not have AIDS. In our institution, we performed 25 CT-guided stereotactic biopsies using the Brown-Roberts-Wells system within a 1-year period. Of these, 11 were performed with a 2-mm-diameter cup forceps, and 14 with a 10-mm-long x 2-mm-diameter side-cutting needle. Abnormal tissue was obtained from all patients, but, in the first group, 5 (45%) biopsies were nondiagnostic, and, in the second group, none (0%) were nondiagnostic. Of the diagnostic biopsies, there was roughly an equal proportion of lymphoma, progressive multifocal leukoencephalopathy, and toxoplasmosis between the two techniques. It is surmised that the deciding factor leading to an enhanced diagnostic yield with the side-cutting needle was the larger amount of tissue obtained with this instrument.