Maragkos Georgios A, Penumaka Anirudh, Ahrendsen Jared T, Salem Mohamed M, Nelton Emmalin B, Alterman Ron L
Neurosurgery Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Neurological Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Neurosurgery Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Neurological Pathology Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
World Neurosurg. 2020 Mar;135:e695-e701. doi: 10.1016/j.wneu.2019.12.102. Epub 2019 Dec 25.
Frame-based stereotactic biopsy (FSB) remains the "gold standard" for obtaining diagnostic samples of intracranial lesions to guide therapy. Nevertheless, diagnostic yield is highly variable. This study aims to provide an analysis of diagnostic yield, surgical complications, and factors associated with obtaining nondiagnostic samples in a contemporary FSB series.
A retrospective cohort study was conducted of all adult patients with imaging-documented lesions undergoing FSB at our institution between 2013 and 2018. Diagnostic accuracy, lesion characteristics associated with nondiagnostic biopsy, and surgical complications were evaluated. A biopsy was considered nondiagnostic if all frozen samples and the final pathology yielded normal brain tissue or nonspecific reactive tissue unless the "reactive" pathology was consistent with radiation injury from prior therapy.
Our search identified 198 FSB patients. Mean (standard deviation) age was 62 ± 17 years, and 44.2% were female. Median procedure time was 32 minutes. A definitive histologic diagnosis was established in 187 cases (94.4% diagnostic yield). Mean lesion diameter was 31.9 ± 16.8 mm. Multivariable logistic regression revealed only lesion diameter to be significantly associated with diagnostic result (odds ratio for nondiagnostic result: 0.94 per mm diameter decrease, 95% confidence interval 0.87-0.99, P = 0.028). On univariable analysis, diagnosis of central nervous system lymphoma appeared to increase the risk of a nondiagnostic biopsy (P = 0.025), but this association disappeared when controlling for lesion size and steroid administration before biopsy. Eight patients (4.0%) developed postoperative hemorrhagic complications, 3 of whom required reoperation, and another expired.
This study demonstrates that diagnostic yield from contemporary FSB is high and depends predominantly on lesion size.
基于框架的立体定向活检（FSB）仍然是获取颅内病变诊断样本以指导治疗的“金标准”。然而，诊断成功率差异很大。本研究旨在分析当代FSB系列中诊断成功率、手术并发症以及与获取非诊断性样本相关的因素。
对2013年至2018年期间在本机构接受FSB且有影像学记录病变的所有成年患者进行回顾性队列研究。评估诊断准确性、与非诊断性活检相关的病变特征以及手术并发症。如果所有冷冻样本和最终病理结果均显示为正常脑组织或非特异性反应性组织，则活检被视为非诊断性，除非“反应性”病理与先前治疗的放射损伤一致。
我们的检索确定了198例FSB患者。平均（标准差）年龄为62±17岁，44.2%为女性。中位手术时间为32分钟。187例（诊断成功率94.4%）确立了明确的组织学诊断。平均病变直径为31.9±16.8毫米。多变量逻辑回归显示，只有病变直径与诊断结果显著相关（非诊断结果的优势比：直径每减少1毫米为0.94，95%置信区间0.87-0.99，P=0.028）。单变量分析显示，中枢神经系统淋巴瘤的诊断似乎会增加非诊断性活检的风险（P=0.025），但在控制病变大小和活检前使用类固醇后，这种关联消失。8例患者（4.0%）出现术后出血并发症，其中3例需要再次手术，另有1例死亡。
本研究表明，当代FSB的诊断成功率很高，且主要取决于病变大小。
