Chabaane Mohamed, Amelot Aymeric, Riche Maximilien, Bielle Franck, Mokhtari Karima, Carpentier Alexandre, Touat Mehdi, Mathon Bertrand
Department of Neurosurgery, La Pitié-Salpêtrière-Charles Foix University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Department of Neuropathology, La Pitié-Salpêtrière-Charles Foix University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
J Clin Neurol. 2020 Oct;16(4):659-667. doi: 10.3988/jcn.2020.16.4.659.
The rationale for performing a second brain biopsy after initial negativity is not well evaluated in the literature. This study was designed to 1) assess the efficacy of a second brain biopsy when the first biopsy was nondiagnostic, 2) identify possible factors associated with an increased diagnostic rate in the second biopsy, and 3) analyze additional morbidity induced by the second biopsy.
We performed a retrospective cohort study from 2009 to 2019, during which 1,919 patients underwent a brain biopsy, including 30 who were biopsied twice (1.6%). The specific histological diagnosis rate, diagnosis-associated factors, and complication rate were assessed for the 30 twice-biopsied patients.
The second biopsy allowed a specific histological diagnosis in 86.7% of the patients who had initially undergone a nondiagnostic brain biopsy [odds ratio (OR)=7.5, 95% confidence interval (CI)=3.0-18.7, <0.001]. The multivariate analysis showed that only prebiopsy corticosteroid administration (OR=2.6, 95% CI=1.1-6.0, =0.01) was an important factor in predicting a nondiagnostic biopsy. None of the patients developed a symptomatic complication after the first biopsy, while two (6.0%) patients experienced a transient complication after the second biopsy (=0.49).
Performing a second brain biopsy in patients who have an initial nondiagnostic biopsy is effective in most cases. We advocate that a second biopsy be systematically considered in the diagnosis algorithm of these patients after it has been verified that molecular testing cannot help to obtain a diagnosis. Corticosteroid administration can lead to nondiagnostic biopsies and should be avoided when possible during the prebiopsy period.
初次活检结果为阴性后再次进行脑活检的理论依据在文献中尚未得到充分评估。本研究旨在：1）评估首次活检未明确诊断时再次进行脑活检的有效性；2）确定与再次活检诊断率增加相关的可能因素；3）分析再次活检引起的额外发病率。
我们进行了一项回顾性队列研究，时间跨度为2009年至2019年，在此期间，1919例患者接受了脑活检，其中30例（1.6%）接受了两次活检。对这30例接受两次活检的患者评估了具体的组织学诊断率、诊断相关因素及并发症发生率。
对于最初脑活检未明确诊断的患者，再次活检使86.7%的患者获得了具体的组织学诊断[比值比（OR）=7.5，95%置信区间（CI）=3.0 - 18.7，P<0.001]。多因素分析显示，只有活检前使用皮质类固醇（OR=2.6，95% CI=1.1 - 6.0，P=0.01）是预测活检未明确诊断的重要因素。首次活检后无患者出现有症状的并发症，而第二次活检后有2例（6.0%）患者出现短暂并发症（P=0.49）。
对于初次活检未明确诊断的患者，再次进行脑活检在大多数情况下是有效的。我们主张，在已证实分子检测无助于获得诊断后，应在这些患者的诊断流程中系统地考虑再次活检。活检前使用皮质类固醇可能导致活检结果未明确诊断，活检前应尽可能避免使用。
