Abstract
Background: When patients present with sim ultaneous lung and brain lesions consistent with metastases, it is often presumed that it is safer and less invasive to biopsy the lung lesion. Objective: To determine whether lung biopsy or stereotactic brain biopsy has a higher diagnostic yield and lower morbidity for tissue diagnosis in patients with simultaneous brain and lung lesions. Methods: Retrospective review of the author’s stereotactic biopsy series and of the literature on brain and lung biopsies for suspected malignancy. Results: The overall diagnostic yield for bronchoscopic lung biopsy ranged from 44% to 88% and the pneumothorax rate from 1.2% to 8%. No deaths were reported. The overall diagnostic yield for transthoracic lung biopsy ranged from 74% to 96% and pneumothorax rate from 2.2% to 8%. No deaths were reported. The overall diagnostic yield for stereotactic brain biopsy ranged from 90.6% to 99.3% when all potential diagnoses are included. Complication rates ranged from 0.6% to 4.8% with mortality from 0% to 1.5%. Several series reported no mortality. Conclusion: Stereotactic brain biopsy has a higher diagnostic yield and a lower complication rate, but a higher mortality. The inclusion of diagnoses other than metastases in the reported series may account for some of the reported mortality. When lung and brain lesions are detected simultaneously, stereotactic biopsy is an excellent option for tissue diagnosis.
Highlights
Background: When patients present with simultaneous lung and brain lesions consistent with metastases, it is often presumed that it is safer and less invasive to biopsy the lung lesion
The overall diagnostic yield for stereotactic brain biopsy ranged from 90.6% to 99.3% when all potential diagnoses are included
When lung and brain lesions are detected simultaneously, stereotactic biopsy is a better option for tissue diagnosis
Summary
When patients present with simultaneous lung and brain lesions consistent with metastases, it is often presumed that it is safer and less invasive to biopsy the lung lesion. Objective: To determine whether lung biopsy or stereotactic brain biopsy has a higher diagnostic yield and lower morbidity for tissue diagnosis in patients with simultaneous brain and lung lesions. Results: The overall diagnostic yield for bronchoscopic lung biopsy ranged from 44% to 88% and the pneumothorax rate from 1.2% to 8%. The overall diagnostic yield for transthoracic lung biopsy ranged from 74% to 96% and pneumothorax rate from 2.2% to 8%. Conclusion: Stereotactic brain biopsy has a higher diagnostic yield and a lower complication rate, but a higher mortality. 2. Method The author reviewed his neurosurgical practice (Michigan and Oregon, USA) stereotactic biopsy series for malignant tumors of the brain and conducted a Medline literature search to compare the safety and efficacy of stereotactic biopsy with the reported safety and efficacy of bronchoscopic and transthoracic lung biopsy. The goal was to learn which is the safer and higher yielding procedure
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