Quick-Weller Johanna, Tichy Julia, Harter Patrick N, Tritt Stephanie, Baumgarten Peter, Bähr Oliver, Dinc Nazife, Behmanesh Bedjan, Weise Lutz, Seifert Volker, Marquardt Gerhard
Department of Neurosurgery, Goethe University Frankfurt, Germany.
Department of Neurooncology, Goethe University Frankfurt, Germany.
J Clin Neurosci. 2018 Jan;47:311-314. doi: 10.1016/j.jocn.2017.09.032. Epub 2017 Oct 24.
Stereotactic procedures are performed in many neurosurgical departments in order to obtain tumor tissue from brain lesions for histopathological evaluation. Biopsies can be performed frame-guided and frame less. Some departments use a biopsy needle (cylinder probe), others a forceps for repetitive smaller tissue samples. Although the applied techniques are somehow different, it is still unclear how many tissue samples have to be taken to establish reliably a final diagnosis based on histopathological and genetic examinations. Only precise histopathological diagnosis results in adequate therapy.
We included 43 consecutive patients who underwent stereotactic biopsy of a suspected glioblastoma between 02/2013 and 07/2015. All patients showed contrast enhancing tumors in the MRI. The patients underwent stereotactic biopsy with the Leksell frame attached to their head. All stereotactic procedures were performed in the presence of a neuropathologist. Target and Entry Points were calculated with BrainLab iplan software (BrainLab iplan 1.0, Munich, Germany). First the two samples 5mm before the Target (pre-target) and the "Targetpoint" itself were analyzed (group 1), then a histopathological evaluation of all samples was performed (group 2).
Mean number of extracted samples was 14. Using classical hematoxylin-eosin stainings, in group 1 histopathological diagnosis was correct in only 30 cases accounting for 73%. Contrariwise a final diagnosis was made in 100% in group 2.
If only two tissue samples were evaluated in this group of patients with suspected glioblastoma, a correct diagnosis was possible in only 73% of the cases. We conclude that two samples are not enough to establish a final diagnosis even in a subgroup of suspected glioblastoma.
许多神经外科科室都开展立体定向手术，以便从脑病变中获取肿瘤组织进行组织病理学评估。活检可在框架引导下或无框架情况下进行。一些科室使用活检针（圆柱探针），另一些科室则使用镊子获取多个较小的组织样本。尽管应用的技术有所不同，但仍不清楚需要采集多少组织样本才能通过组织病理学和基因检查可靠地做出最终诊断。只有精确的组织病理学诊断才能带来恰当的治疗。
我们纳入了2013年2月至2015年7月期间连续43例接受疑似胶质母细胞瘤立体定向活检的患者。所有患者在磁共振成像（MRI）上均显示有强化肿瘤。患者头部固定Leksell框架后接受立体定向活检。所有立体定向手术均在神经病理学家在场的情况下进行。使用BrainLab iplan软件（BrainLab iplan 1.0，德国慕尼黑）计算靶点和入点。首先分析靶点前5毫米处的两个样本（靶点前样本）和“靶点”本身（第1组），然后对所有样本进行组织病理学评估（第2组）。
提取的样本平均数为14个。使用经典苏木精-伊红染色，第1组中组织病理学诊断仅在30例中正确，占73%。相反，第2组的最终诊断正确率为100%。
在这组疑似胶质母细胞瘤患者中，如果仅评估两个组织样本，仅73%的病例能做出正确诊断。我们得出结论，即使在疑似胶质母细胞瘤的亚组中，两个样本也不足以做出最终诊断。
