Woodworth Graeme, McGirt Matthew J, Samdani Amer, Garonzik Ira, Olivi Alessandro, Weingart Jon D
Departments of Neurosurgery and Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
Neurol Res. 2005 Jun;27(4):358-62. doi: 10.1179/016164105X40057.
Tissue heterogeneity and rapid tumor progression may decrease the accuracy a prognostic value of stereotactic brain biopsy in the diagnosis of gliomas. Correct tumor grading is therefore dependent on the accuracy of biopsy needle placement. There has been a dramatic increase in the utilization of frameless image-guided stereotactic brain biopsy; however, its accuracy in the diagnosis of glioma remains unstudied.
The diagnoses of 21 astrocytic brain tumors were derived using image-guided stereotactic biopsy (12 frame-based, nine frameless) and followed by open resection of the lesion 1.5 (0.5-4) months later. The histologic diagnoses yielded by the biopsy were compared with subsequent histologic diagnosis from open tumor resection.
Histology of 21 stereotactic biopsies accurately represented the greater lesion at open resection a median of 45 days later in 16 (76%) cases and correctly guided therapy in 19 (91%) cases. Biopsy accuracy of frameless versus frame-based stereotaxis was similar (89 versus 66%, p=0.21). In three (14%) cases, biopsy specimens were adequate to diagnose glioma; however, histology was insufficient for definitive tumor grading. Anaplastic oligodendroglioma (ODG) was under-graded as low-grade ODG in one (5%) case. Biopsy of new onset glioblastoma multiforme (GBM) yielded necrosis/gliosis and was termed non-diagnostic in one patient. Tumors <50 cm(3) were 8-fold less likely to accurately represent the grade of the entire lesion at resection compared with lesions <50 cm(3) (OR, 8.8; 95% CI, 0.9-100, p=0.05).
Both frameless and frame-based MRI-guided stereotactic brain biopsy are safe and accurately represent the larger glioma mass sufficiently to guide subsequent therapy. Large tumor volume had a higher incidence of non-concordance. Increasing the number of specimens taken through the long dimension of large tumors may improve diagnostic accuracy.
组织异质性和肿瘤快速进展可能会降低立体定向脑活检在胶质瘤诊断中预后价值的准确性。因此，正确的肿瘤分级取决于活检针放置的准确性。无框架图像引导立体定向脑活检的应用显著增加；然而，其在胶质瘤诊断中的准确性仍未得到研究。
采用图像引导立体定向活检（12例基于框架，9例无框架）对21例星形细胞脑肿瘤进行诊断，1.5（0.5 - 4）个月后对病变进行开放性切除。将活检产生的组织学诊断与随后开放性肿瘤切除的组织学诊断进行比较。
21例立体定向活检的组织学结果在中位45天后准确代表了16例（76%）开放性切除时的较大病变，19例（91%）病例中正确指导了治疗。无框架与基于框架的立体定向活检准确性相似（89%对66%，p = 0.21）。在3例（14%）病例中，活检标本足以诊断胶质瘤；然而，组织学不足以进行明确的肿瘤分级。1例（5%）间变性少突胶质细胞瘤被低分级为低级别少突胶质细胞瘤。1例新发性多形性胶质母细胞瘤活检显示坏死/胶质增生，被判定为非诊断性。与>50 cm³ 的病变相比，<50 cm³ 的肿瘤在切除时准确代表整个病变分级的可能性低8倍（OR，8.8；95% CI，0.9 - 100，p = 0.05）。
无框架和基于框架的MRI引导立体定向脑活检都是安全的，并且能充分准确地代表较大的胶质瘤肿块以指导后续治疗。大肿瘤体积不一致的发生率更高。增加通过大肿瘤长径获取的标本数量可能会提高诊断准确性。
