Quick-Weller Johanna, Kann Gerrit, Lescher Stephanie, Imöhl Lioba, Seifert Volker, Weise Lutz Martin, Brodt Hans-Reinhard, Marquardt Gerhard
Neurosurgical Clinic, Goethe-University Frankfurt, Germany.
Medical Clinic II, Goethe-University Frankfurt, Germany.
World Neurosurg. 2016 Feb;86:300-5. doi: 10.1016/j.wneu.2015.09.037. Epub 2015 Sep 25.
During their disease a significant number of human immunodeficiency virus (HIV)-infected patients develop neurologic symptoms due to intracerebral pathologies. Entities commonly found are toxoplasmosis, lymphomas, or progressive multifocal leukoencephalopathy. In some patients, diagnosis is not feasible with imaging alone, requiring biopsy. The objective of this study was to evaluate the impact of stereotactic biopsy in HIV patients on adjustment of therapy.
Between January 2004 and May 2015 at our clinic, 26 HIV-infected patients underwent stereotactic biopsy. Thin-layer magnetic resonance images were obtained and fused with computed tomography scans, taken with the stereotactic frame (Leksell) mounted. Biopsy material was evaluated pathologically and microbiologically.
Histologic analysis revealed B-cell lymphoma in 6 patients (23.1%) and progressive multifocal leukoencephalopathy in 2 patients (7.7%). Abscess and toxoplasmosis were found in 3 patients each (11.5% and 11.5%), and encephalitis occurred in 4 patients (15.4%). In 2 patients each (7.7%), vasculitis, metastasis, and glioblastoma were diagnosed. Further findings comprised non-Hodgkin lymphoma and Burkitt lymphoma in 1 patient each. After biopsy, treatment was significantly changed in 18 (69.2%) patients (P < 0.01). Antibiotic therapy was adjusted in 6 patients (23.1%), and chemotherapy in 3 patients (16.7%). Other changes included antibiotic/antiviral therapy to chemotherapy in 3 patients (16.7%), chemotherapy to radiation, cortisone to chemotherapy, and aciclovir to cortisone in 1 patient each. One patient with glioblastoma underwent resection, and another patient received radiation. One patient underwent palliative care.
Stereotactic biopsy in HIV-infected patients results in significant changes of therapy in more than two thirds of the patients.
在患病期间，相当数量的人类免疫缺陷病毒（HIV）感染患者会因脑内病变出现神经症状。常见的病症有弓形虫病、淋巴瘤或进行性多灶性白质脑病。在一些患者中，仅靠影像学检查无法确诊，需要进行活检。本研究的目的是评估立体定向活检对HIV患者治疗调整的影响。
2004年1月至2015年5月期间，在我们诊所，26例HIV感染患者接受了立体定向活检。获取薄层磁共振图像，并与安装有立体定向框架（Leksell）的计算机断层扫描图像融合。对活检材料进行病理和微生物学评估。
组织学分析显示，6例患者（23.1%）为B细胞淋巴瘤，2例患者（7.7%）为进行性多灶性白质脑病。3例患者（各占11.5%）发现脓肿和弓形虫病，4例患者（15.4%）发生脑炎。各有2例患者（7.7%）被诊断为血管炎、转移瘤和胶质母细胞瘤。其他发现包括1例患者为非霍奇金淋巴瘤，1例患者为伯基特淋巴瘤。活检后，18例（69.2%）患者的治疗发生了显著变化（P<0.01）。6例患者（23.1%）调整了抗生素治疗，3例患者（16.7%）调整了化疗。其他变化包括3例患者（16.7%）从抗生素/抗病毒治疗改为化疗，1例患者分别从化疗改为放疗、从皮质类固醇改为化疗、从阿昔洛韦改为皮质类固醇。1例胶质母细胞瘤患者接受了切除术，另1例患者接受了放疗。1例患者接受了姑息治疗。
HIV感染患者的立体定向活检导致超过三分之二的患者治疗发生显著变化。
