Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0044-1789593
Original Article

Improving Diagnostic Yield and Accuracy of Stereotactic Biopsies through Changes in Practice and Techniques: An 8-Year Single-Center Comparative Study

Kugan Vijian
1   Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak, Malaysia
,
Bik Liang Lau
1   Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak, Malaysia
,
Davendran Kanesen
1   Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak, Malaysia
,
Swee San Lim
1   Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak, Malaysia
,
Donald L. Ngian
1   Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak, Malaysia
,
Albert S. Hieng Wong
1   Department of Neurosurgery, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak, Malaysia
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Stereotactic biopsies are used to aid neurosurgeons in clinching the diagnosis of intracranial lesions that are difficult to access surgically. A published study of stereotactic biopsies in our center demonstrated a diagnostic yield of only 76% for biopsies from the year 2014 to 2019. A set of criteria/prerequisites was applied to increase yield.

Objective The aim of the study was to identify the improvement in accuracy and yield after implementation of a set of criteria/prerequisites.

Materials and Methods This was a retrospective and prospective analysis of all patients who underwent stereotactic biopsies from the year 2014 to 2022. This study was conducted at Sarawak General Hospital, Malaysia. A set of stereotactic criteria/prerequisites was introduced since 2020, which include preoperative careful, meticulous trajectory planning and target selection, regular checking and maintenance of equipment, larger burr holes, and good sampling techniques.

Results A total of 83 patients underwent stereotactic biopsies from the year 2014 to 2022. Frameless and frame-based methods were used for 45 (54%) and 38 (46%) patients, respectively. The overall diagnostic yield of all biopsies was 84%. Fifty patients underwent stereotactic biopsies prior to implementation of good practice guidelines in 2020 with a positive histopathological yield and accuracy of 76 and 88%, respectively. Thirty-three biopsies done postimplementation demonstrated a yield and accuracy of 97% (p < 0.05). There was also a shift of preference toward frame-based methods after 2019, with 85% of these biopsies being frame based.

Conclusion This comparative study shows that adherence to specific stereotactic biopsy guidelines and techniques introduced in our center has successfully improved our biopsy yield and accuracy.

Keywords

stereotactic biopsy - diagnostic yield - accuracy

Authors' Contributions

K.V, B.L.L., and A.S.H.W. have given substantial contributions to the conception and the design of the manuscript. S.S.L. and D.L.N. have contributed in providing the samples and designing the methodology. K.V, B.L.L., and D.K. have contributed to acquisition, analysis, and interpretation of the data. All the authors participated in drafting the manuscript, and author A.S.H.W. revised it critically. All the authors contributed equally to the manuscript and read and approved the final version of the manuscript.




Publication History

Article published online:
02 September 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Di Bonaventura R, Montano N, Giordano M. et al. Reassessing the role of brain tumor biopsy in the era of advanced surgical, molecular, and imaging techniques-a single-center experience with long-term follow-up. J Pers Med 2021; 11 (09) 909
    CrossrefPubMedGoogle Scholar
  • 2 Giannetti AV, Alvarenga AY, de Lima TO, Pedrosa HA, Souweidane MM. Neuroendoscopic biopsy of brain lesions: accuracy and complications. J Neurosurg 2015; 122 (01) 34-39
    CrossrefPubMedGoogle Scholar
  • 3 Dhawan S, He Y, Bartek Jr J, Alattar AA, Chen CC. Comparison of frame-based versus frameless intracranial stereotactic biopsy: systematic review and meta-analysis. World Neurosurg 2019; 127: 607-616.e4
    CrossrefPubMedGoogle Scholar
  • 4 Couldwell WT, Apuzzo ML. Initial experience related to the use of the Cosman-Roberts-Wells stereotactic instrument. Technical note. J Neurosurg 1990; 72 (01) 145-148
    CrossrefPubMedGoogle Scholar
  • 5 Lau BL, Idris Z, Abdullah JM, Bujang MA, Wong ASH. Introduction of a newly created AW stereotactic frame: a phantom-based accuracy evaluation and an initial experience in clinical usage. Br J Neurosurg 2023; 37 (06) 1572-1579
    CrossrefPubMedGoogle Scholar
  • 6 Lau BL, Vijian K, Liew DNS, Wong ASH. Factors affecting diagnostic yield in stereotactic biopsy for brain lesions: a 5-year single-center series. Neurosurg Rev 2022; 45 (02) 1473-1480
    CrossrefPubMedGoogle Scholar
  • 7 Furneaux CE, Marshall ES, Yeoh K. et al. Cell cycle times of short-term cultures of brain cancers as predictors of survival. Br J Cancer 2008; 99 (10) 1678-1683
    CrossrefPubMedGoogle Scholar
  • 8 Lu Y, Yeung C, Radmanesh A, Wiemann R, Black PM, Golby AJ. Comparative effectiveness of frame-based, frameless, and intraoperative magnetic resonance imaging-guided brain biopsy techniques. World Neurosurg 2015; 83 (03) 261-268
    CrossrefPubMedGoogle Scholar
  • 9 Bériault S, Subaie FA, Collins DL, Sadikot AF, Pike GB. A multi-modal approach to computer-assisted deep brain stimulation trajectory planning. Int J Comput Assist Radiol Surg 2012; 7 (05) 687-704
    CrossrefPubMedGoogle Scholar
  • 10 Sparks R, Vakharia V, Rodionov R. et al. Anatomy-driven multiple trajectory planning (ADMTP) of intracranial electrodes for epilepsy surgery. Int J Comput Assist Radiol Surg 2017; 12 (08) 1245-1255
    CrossrefPubMedGoogle Scholar
  • 11 Apuzzo ML, Chandrasoma PT, Cohen D, Zee CS, Zelman V. Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 1987; 20 (06) 930-937
    CrossrefPubMedGoogle Scholar
  • 12 Porter AB, Giannini C, Kaufmann T. et al. Primary central nervous system lymphoma can be histologically diagnosed after previous corticosteroid use: a pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma. Ann Neurol 2008; 63 (05) 662-667
    CrossrefPubMedGoogle Scholar
  • 13 Binnahil M, Au K, Lu J-Q, Wheatley BM, Sankar T. The influence of corticosteroids on diagnostic accuracy of biopsy for primary central nervous system lymphoma. Can J Neurol Sci 2016; 43 (05) 721-725
    CrossrefPubMedGoogle Scholar
  • 14 Önder E, Arıkök AT, Önder S. et al. Corticosteroid pre-treated primary CNS lymphoma: a detailed analysis of stereotactic biopsy findings and consideration of interobserver variability. Int J Clin Exp Pathol 2015; 8 (07) 7798-7808
    PubMedGoogle Scholar
  • 15 Brück W, Brunn A, Klapper W. et al; Netzwerk Lymphome und Lymphomatoide Läsionen des Nervensystems. Differential diagnosis of lymphoid infiltrates in the central nervous system: experience of the Network Lymphomas and Lymphomatoid Lesions in the Nervous System. Pathologe 2013; 34 (03) 186-197
    PubMedGoogle Scholar
  • 16 Elias WJ, Fu KM, Frysinger RC. Cortical and subcortical brain shift during stereotactic procedures. J Neurosurg 2007; 107 (05) 983-988
    CrossrefPubMedGoogle Scholar
  • 17 Zonenshayn M, Sterio D, Kelly PJ, Rezai AR, Beric A. Location of the active contact within the subthalamic nucleus (STN) in the treatment of idiopathic Parkinson's disease. Surg Neurol 2004; 62 (03) 216-225 , discussion 225–226
    CrossrefPubMedGoogle Scholar
  • 18 Trojanowski P, Jarosz B, Szczepanek D. The diagnostic quality of needle brain biopsy specimens obtained with different sampling methods: experimental study. Sci Rep 2019; 9 (01) 8077
    CrossrefPubMedGoogle Scholar
  • 19 Vernau KM, Higgins RJ, Bollen AW. et al. Primary canine and feline nervous system tumors: intraoperative diagnosis using the smear technique. Vet Pathol 2001; 38 (01) 47-57
    CrossrefPubMedGoogle Scholar