Stereotactic biopsy in the era of advanced neuroimaging. Does the minimal therapeutic gain justify its current wide use?

Abstract

Objective: This study reviewed the contribution of stereotactic brain biopsy in the management and final outcome of a series of patients with presumed inoperable lesions.

Patients and methods: Sixty-nine consecutive patients underwent a CT-guided lesion biopsy (n = 67) or abscess/cyst aspiration (n = 2) using the Cosman-Roberts-Wells (CRW) frame.

Results: A definitive specific diagnosis was made in 53 of 67 patients (79 %). The remaining procedures did not provide a diagnosis because of failure to obtain appropriate specimen (11 patients), findings consistent with non-specific inflammation (2 patients) or uneventful surgical complication requiring termination of the procedure (1 patient). A total of 55 patients (80 %) died due to the malignant nature of the lesion, most within six months after the biopsy. The preoperative imaging diagnosis was consistent with the histological diagnosis in 60 patients (87 % accuracy). The perioperative morbidity and mortality were nil and most of the patients were discharged within twenty-four hours.

Conclusions: The stereotactic biopsy did not alter either the therapeutic management or the mortality due to the natural course of the lesion. These findings indicate that the current principle of mandatory histological diagnosis in virtually all non-resectable brain lesions should be re-evaluated taking into account parameters such as: age, medical/neurological status, neuroimaging characteristics, patients' best interest and health care financial shortages.