Tilgner Johannes, Herr Manfred, Ostertag Christoph, Volk Benedikt
Abteilung Neuropathologie, Universität Freiburg, Freiburg, Germany.
Neurosurgery. 2005 Feb;56(2):257-65; discussion 257-65. doi: 10.1227/01.neu.0000148899.39020.87.
Despite improvements in imaging techniques, histopathological diagnosis is still an important tool in neuro-oncology. At Freiburg University Hospital in Germany, approximately 450 patients per year undergo a serial stereotactic biopsy to obtain a diagnosis. We analyzed the accuracy of intraoperative diagnosis for rapid establishment of treatment options. Furthermore, we wanted to find out whether the location and histopathology of the tumors as well as the age and sex of the patients affected accuracy. Because of the large number of biopsies performed per year, parameters could also be evaluated for rare cerebral lesions.
We retrospectively analyzed 5000 consecutive stereotactic brain biopsies from 4589 patients. The digital database comprises the intraoperative and final diagnoses, the location of the tumors, and the sex and age of the patients. Regression analysis was performed to identify parameters that had a significant impact on the results.
Intraoperative diagnosis was correct in 90.3% of biopsies. This included complete correlation in 81.3% of the biopsies and partial correlation in 9% of the biopsies. In 5.1% of the biopsies, no correlation between the intraoperative and final diagnosis was obtained. In 4.6% of the biopsies, no diagnosis could be made during or after surgery. A high correlation was found for World Health Organization Type II astrocytomas and, with regression analysis, for World Health Organization Type I astrocytomas, glioblastomas, and metastases.
Intraoperative diagnosis with stereotactic biopsy has high validity. Immediate treatment based on the intraoperative diagnosis can be justified (e.g., for metastases or glioblastomas). Stereotactic biopsy with an exact histopathological diagnosis is strongly recommended for planning adequate therapy for patients with unidentified brain lesions.
尽管成像技术有所改进，但组织病理学诊断仍是神经肿瘤学中的一项重要工具。在德国弗莱堡大学医院，每年约有450名患者接受系列立体定向活检以获得诊断。我们分析了术中诊断对于快速确定治疗方案的准确性。此外，我们想了解肿瘤的位置和组织病理学以及患者的年龄和性别是否会影响准确性。由于每年进行大量活检，对于罕见脑病变的参数也可进行评估。
我们回顾性分析了4589例患者连续进行的5000次立体定向脑活检。数字数据库包括术中及最终诊断、肿瘤位置以及患者的性别和年龄。进行回归分析以确定对结果有显著影响的参数。
90.3%的活检术中诊断正确。其中81.3%的活检完全相符，9%的活检部分相符。5.1%的活检术中与最终诊断无相关性。4.6%的活检在手术期间或术后无法做出诊断。世界卫生组织II级星形细胞瘤的相关性较高，经回归分析，世界卫生组织I级星形细胞瘤、胶质母细胞瘤和转移瘤的相关性也较高。
立体定向活检的术中诊断具有较高的有效性。基于术中诊断进行即时治疗是合理的（例如，对于转移瘤或胶质母细胞瘤）。强烈建议对不明脑病变患者进行立体定向活检并获得准确的组织病理学诊断，以便规划适当的治疗方案。
