Frame-based Stereotactic Biopsy: Description and Association of Anatomical, Radiologic, and Surgical Variables with Diagnostic Yield in a Series of 407 Cases
Frame-based Stereotactic Biopsy: Description and Association of Anatomical, Radiologic, and Surgical Variables with Diagnostic Yield in a Series of 407 Cases
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DOI：
10.1055/s-0038-1676597
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发表时间：
2019-05-01
影响因子：
1
通讯作者：
Hernandez-Vicente, Javier
中科院分区：
文献类型：
--
作者：
Lara-Almunia, Monica;Hernandez-Vicente, Javier
背景和研究目的立体定向活检是一种多功能、微创技术，可以安全地从颅内病变中获取组织，用于组织学诊断和治疗管理。我们的目的是确定可能影响该技术诊断率的解剖学、放射学和技术因素。我们提出建议，以提高其在临床practice.Methods的使用，这项回顾性研究评估了407例患者进行立体定向活检在过去的34年。手术方法随着时间的推移而变化，分为三个不同的时期。使用了不同的立体定向框架（Todd-Wells、CRW、Leksell）、神经影像学检查和计划程序。结果本组病例中男性265例（65.1%），女性142例（34.9%），平均年龄53.8岁。诊断率为90.4%，发病率为5.65%（n =17），死亡率为0.98%（n =4）。术中活检提高了准确性（p =0.024）。深部病变活检（p =0.043）、无造影剂增强（p =0.004）、水肿（p =0.036）、广泛坏死（p =0.028）或大囊性成分（p =0.023）导致诊断率较差。立体定向技术经验不足的神经外科医生获得了更多的非诊断性活检（p =0.043）。经验是最明确的预测因素的诊断率（优势比：4.049）。结论增加立体定向技术的经验，使用最合适的磁共振成像序列在活检计划，并在完成收集前的样本的术中评价，建议功能和方法，以提高诊断率的这种技术。
Background and Study Aims Stereotactic biopsy is a versatile, minimally invasive technique to obtain tissue safely from intracranial lesions for their histologic diagnosis and therapeutic management. Our objective was to determine the anatomical, radiologic, and technical factors that can affect the diagnostic yield of this technique. We suggest recommendations to improve its use in clinical practice.Methods This retrospective study evaluated 407 patients who underwent stereotactic biopsies in the past 34 years. The surgical methodology changed through time, distinguished by three distinct periods. Different stereotactic frames (Todd-Wells, CRW, Leksell), neuroimaging tests, and planning programs were used. Using SPSS software v.23, we analyzed a total of 50 variables for each case.Results The series included 265 men (65.1%) and 142 women (34.9%) (average age 53.8 years). The diagnostic yield was 90.4%, morbidity was 5.65% ( n =17), and mortality was 0.98% ( n =4). Intraoperative biopsy improved accuracy ( p =0.024). Biopsies of deep lesions ( p =0.043), without contrast enhancement ( p =0.004), edema ( p =0.036), extensive necrosis ( p =0.028), or a large cystic component ( p =0.023) resulted in a worse diagnostic yield. Neurosurgeons inexperienced in stereotactic techniques obtained more nondiagnostic biopsies ( p =0.043). Experience was the clearest predictive factor of diagnostic yield (odds ratio: 4.049).Conclusions Increased experience in stereotactic techniques, use of the most suitable magnetic resonance imaging sequences during biopsy planning, and intraoperative evaluation of the sample before finalizing the collection are recommended features and ways to improve the diagnostic yield of this technique.