Department of Surgery, Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China.
J Neurol Surg A Cent Eur Neurosurg. 2024 Jan;85(1):48-61. doi: 10.1055/a-1994-8033. Epub 2022 Dec 8.
The diagnostic accuracy of frameless stereotactic brain biopsy has been reported, but there is limited literature focusing on the reasons for nondiagnostic cases. In this study, we evaluate the diagnostic accuracy of frameless stereotactic brain biopsy, compare it with the current international standard, and review the field for improvement.
This is a retrospective analysis of consecutive, prospectively collected frameless stereotactic brain biopsies from 2007 to 2020. We evaluated the diagnostic accuracy of the frameless stereotactic brain biopsies using defined criteria. The biopsy result was classified as conclusive, inconclusive, or negative, based on the pathologic, radiologic, and clinical diagnosis concordance. For inconclusive or negative results, we further evaluated the preoperative planning and postoperative imaging to review the errors. A literature review for the diagnostic accuracy of frameless stereotactic biopsy was performed for the validity of our results.
There were 106 patients with 109 biopsies performed from 2007 to 2020. The conclusive diagnosis was reached in 103 (94.5%) procedures. An inconclusive diagnosis was noted in four (3.7%) procedures and the biopsy was negative in two (1.9%) procedures. Symptomatic hemorrhage occurred in one patient (0.9%). There was no mortality in our series. Registration error (RE) and inaccurate targeting occurred in three trigonal lesions (2.8%), sampling of the nonrepresentative part of the lesion occurred in two cases (1.8%), and one biopsy (0.9%) for lymphoma was negative due to steroid treatment. The literature review suggested that our diagnostic accuracy was comparable with the published literature.
The frameless stereotactic biopsy is a safe procedure with high diagnostic accuracy only if meticulous preoperative planning and careful intraoperative registration is performed. The common pitfalls precluding a conclusive diagnosis are RE and biopsies at nonrepresentative sites.
无框架立体定向脑活检的诊断准确性已有报道，但针对非诊断性病例的原因，相关文献有限。在本研究中，我们评估了无框架立体定向脑活检的诊断准确性，将其与当前国际标准进行比较，并对改进领域进行了回顾。
这是一项对 2007 年至 2020 年连续前瞻性收集的无框架立体定向脑活检进行的回顾性分析。我们使用明确的标准评估无框架立体定向脑活检的诊断准确性。根据病理、影像学和临床诊断的一致性，将活检结果分为明确诊断、不确定诊断和阴性。对于不确定或阴性的结果，我们进一步评估术前计划和术后影像学，以检查错误。为了验证我们结果的有效性，我们对无框架立体定向活检的诊断准确性进行了文献回顾。
2007 年至 2020 年期间，共对 106 例患者的 109 次活检进行了研究。103 例（94.5%）获得明确诊断，4 例（3.7%）诊断不确定，2 例（1.9%）活检阴性。1 例患者（0.9%）发生症状性出血。本系列无死亡病例。在 3 例三角区病变（2.8%）中出现了注册误差（RE）和定位不准确，2 例（1.8%）病变的非代表性部分取样，1 例（0.9%）因皮质类固醇治疗而导致淋巴瘤活检阴性。文献回顾表明，我们的诊断准确性与已发表的文献相当。
只要进行细致的术前规划和术中仔细的注册，无框架立体定向活检是一种安全的操作，具有很高的诊断准确性。排除明确诊断的常见陷阱是 RE 和非代表性部位的活检。
