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Mazzucchi E, Galieri G, Pignotti F, Rinaldi P, Sabatino G, La Rocca G. Combination of Tractography, Intraoperative Computed Tomography and 5-Aminolevulinic Acid Fluorescence in Stereotactic Brain Biopsies: A Case Series. J Pers Med 2024; 14:357. [PMID: 38672985 PMCID: PMC11051181 DOI: 10.3390/jpm14040357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Stereotactic needle biopsy (SNB) may be performed to collect tissue samples from lesions not amenable to open surgery. Integration of tractography, intraoperative imaging and fluorescence has been applied to reduce risk of complications and confirm the adequacy of bioptic specimens. Clinical and radiological data from patients who underwent stereotactic needle biopsy with the use of intraoperative CT, tractography and 5-aminolevulinic acid (5-ALA) fluorescence in a single Hospital were retrospectively reviewed to evaluate the accuracy and safety of the procedure. Seven patients were included in the study, and all the collected specimens showed red fluorescence. In six of them, the final histopathological diagnosis was grade 4 glioblastoma IDH-wt and in the other case it was Diffuse large B-Cell Lymphoma. The integration of tractography, intraoperative CT and 5-ALA as an intraoperative marker of diagnostic samples may be suggested in biopsies of suspect gliomas and lymphomas. The cost-effectiveness of the procedure should be evaluated in future studies.
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Affiliation(s)
- Edoardo Mazzucchi
- Unit of Neurosurgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Gianluca Galieri
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, 00168 Rome, Italy; (G.G.); (G.S.); (G.L.R.)
| | | | | | - Giovanni Sabatino
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, 00168 Rome, Italy; (G.G.); (G.S.); (G.L.R.)
| | - Giuseppe La Rocca
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, 00168 Rome, Italy; (G.G.); (G.S.); (G.L.R.)
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Rejimon AC, Ramesh KK, Trivedi AG, Huang V, Schreibmann E, Weinberg BD, Kleinberg LR, Shu HKG, Shim H, Olson JJ. The Utility of Spectroscopic MRI in Stereotactic Biopsy and Radiotherapy Guidance in Newly Diagnosed Glioblastoma. Tomography 2024; 10:428-443. [PMID: 38535775 PMCID: PMC10975697 DOI: 10.3390/tomography10030033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024] Open
Abstract
Current diagnostic and therapeutic approaches for gliomas have limitations hindering survival outcomes. We propose spectroscopic magnetic resonance imaging as an adjunct to standard MRI to bridge these gaps. Spectroscopic MRI is a volumetric MRI technique capable of identifying tumor infiltration based on its elevated choline (Cho) and decreased N-acetylaspartate (NAA). We present the clinical translatability of spectroscopic imaging with a Cho/NAA ≥ 5x threshold for delineating a biopsy target in a patient diagnosed with non-enhancing glioma. Then, we describe the relationship between the undertreated tumor detected with metabolite imaging and overall survival (OS) from a pilot study of newly diagnosed GBM patients treated with belinostat and chemoradiation. Each cohort (control and belinostat) were split into subgroups using the median difference between pre-radiotherapy Cho/NAA ≥ 2x and the treated T1-weighted contrast-enhanced (T1w-CE) volume. We used the Kaplan-Meier estimator to calculate median OS for each subgroup. The median OS was 14.4 months when the difference between Cho/NAA ≥ 2x and T1w-CE volumes was higher than the median compared with 34.3 months when this difference was lower than the median. The T1w-CE volumes were similar in both subgroups. We find that patients who had lower volumes of undertreated tumors detected via spectroscopy had better survival outcomes.
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Affiliation(s)
- Abinand C. Rejimon
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Karthik K. Ramesh
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Anuradha G. Trivedi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Vicki Huang
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Eduard Schreibmann
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
| | - Brent D. Weinberg
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA;
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Lawrence R. Kleinberg
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21218, USA;
| | - Hui-Kuo G. Shu
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Hyunsuk Shim
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA; (A.C.R.); (K.K.R.); (E.S.); (H.-K.G.S.); (H.S.)
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA;
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Jeffrey J. Olson
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
- Department of Neurosurgery, Emory University, Atlanta, GA 30322, USA
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Mauler J, Lohmann P, Maudsley AA, Sheriff S, Hoevels M, Meissner AK, Hamisch C, Brunn A, Deckert M, Filss CP, Stoffels G, Dammers J, Ruge MI, Galldiks N, Mottaghy FM, Langen KJ, Shah NJ. Diagnostic Accuracy of MR Spectroscopic Imaging and 18F-FET PET for Identifying Glioma: A Biopsy-Controlled Hybrid PET/MRI Study. J Nucl Med 2024; 65:16-21. [PMID: 37884332 DOI: 10.2967/jnumed.123.265868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/22/2023] [Indexed: 10/28/2023] Open
Abstract
Contrast-enhanced MRI is the method of choice for brain tumor diagnostics, despite its low specificity for tumor tissue. This study compared the contribution of MR spectroscopic imaging (MRSI) and amino acid PET to improve the detection of tumor tissue. Methods: In 30 untreated patients with suspected glioma, O-(2-[18F]fluoroethyl)-l-tyrosine (18F-FET) PET; 3-T MRSI with a short echo time; and fluid-attenuated inversion recovery, T2-weighted, and contrast-enhanced T1-weighted MRI were performed for stereotactic biopsy planning. Serial samples were taken along the needle trajectory, and their masks were projected to the preoperative imaging data. Each sample was individually evaluated neuropathologically. 18F-FET uptake and the MRSI signals choline (Cho), N-acetyl-aspartate (NAA), creatine, myoinositol, and derived ratios were evaluated for each sample and classified using logistic regression. The diagnostic accuracy was evaluated by receiver operating characteristic analysis. Results: On the basis of the neuropathologic evaluation of tissue from 88 stereotactic biopsies, supplemented with 18F-FET PET and MRSI metrics from 20 areas on the healthy-appearing contralateral hemisphere to balance the glioma/nonglioma groups, 18F-FET PET identified glioma with the highest accuracy (area under the receiver operating characteristic curve, 0.89; 95% CI, 0.81-0.93; threshold, 1.4 × background uptake). Among the MR spectroscopic metabolites, Cho/NAA normalized to normal brain tissue showed the highest diagnostic accuracy (area under the receiver operating characteristic curve, 0.81; 95% CI, 0.71-0.88; threshold, 2.2). The combination of 18F-FET PET and normalized Cho/NAA did not improve the diagnostic performance. Conclusion: MRI-based delineation of gliomas should preferably be supplemented by 18F-FET PET.
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Affiliation(s)
- Jörg Mauler
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany;
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sulaiman Sheriff
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Moritz Hoevels
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna-Katharina Meissner
- Department of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christina Hamisch
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Brunn
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuropathology, University Hospital Düsseldorf and Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuropathology, University Hospital Düsseldorf and Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian P Filss
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
| | - Jürgen Dammers
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
| | - Maximillian I Ruge
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Center for Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany
- Center for Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany
- Center for Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine (INM-3/INM-4/INM-11), Forschungszentrum Juelich, Juelich, Germany
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany; and
- JARA-BRAIN-Translational Medicine, Aachen, Germany
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Zanello M, Debacker C, Moiraghi A, Peeters S, Roux A, Deboeuf L, Parraga E, Dezamis E, Chrétien F, Oppenheim C, Pallud J. Use of MR signal intensity variations to highlight structures at risk along brain biopsy trajectories. J Neurosurg 2024; 140:116-126. [PMID: 37548577 DOI: 10.3171/2023.5.jns23263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/24/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Postoperative intracerebral hemorrhages are significant complications following brain stereotactic biopsy. They can derive from anatomical structure (sulci, vessels) damage that is missed during stereotactic trajectory planning. In this study, the authors investigated the ability to detect contact between structures at risk and stereotactic trajectories using signal analysis from MRI obtained during clinical practice, with the aim to propose a visual tool to highlight areas with anatomical structures at risk of damage along the biopsy trajectory. METHODS The authors retrospectively analyzed actual stereotactic trajectories using intraoperative imaging (intraoperative 2D radiographs in the exploratory data set and intraoperative 3D scans in the confirmatory data set). The MR signal variation along each biopsy trajectory was matched with the patient's anatomy. RESULTS In the exploratory data set (n = 154 patients), 32 contacts between the actual biopsy trajectory and an anatomical structure at risk were identified along 28 (18.2%) biopsy trajectories, corresponding to 8 preventable intracerebral hemorrhages. Variations of the mean derivative of the MR signal intensity were significantly different between trajectories with and without contact (the pathological threshold of the mean derivative of the MR signal intensity was defined as ± 0.030 arbitrary units; p < 0.0001), with a sensitivity of 89.3% and specificity of 74.6% to detect a contact. In the confirmatory data set (n = 73 patients), the sensitivity and specificity of the 0.030 threshold to detect a contact between the actual stereotactic trajectory and an anatomical structure at risk were 81.3% and 68.4%, respectively. CONCLUSIONS Variations of the mean derivative of the MR signal intensity can be converted into a green/red color code along the planned biopsy trajectory to highlight anatomical structures at risk, which can help neurosurgeons during the surgical planning of stereotactic procedures.
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Affiliation(s)
- Marc Zanello
- Departments of1Neurosurgery
- 2University Paris Cité, Paris
- 3UMR 1266, INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, France; and
| | - Clément Debacker
- 2University Paris Cité, Paris
- 3UMR 1266, INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, France; and
| | - Alessandro Moiraghi
- Departments of1Neurosurgery
- 2University Paris Cité, Paris
- 3UMR 1266, INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, France; and
| | - Sophie Peeters
- 4Department of Neurosurgery, University of California, Los Angeles, California
| | - Alexandre Roux
- Departments of1Neurosurgery
- 2University Paris Cité, Paris
- 3UMR 1266, INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, France; and
| | - Louise Deboeuf
- Departments of1Neurosurgery
- 2University Paris Cité, Paris
| | | | | | | | - Catherine Oppenheim
- 2University Paris Cité, Paris
- 3UMR 1266, INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, France; and
- 6Neuroradiology, GHU Paris-Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris
| | - Johan Pallud
- Departments of1Neurosurgery
- 2University Paris Cité, Paris
- 3UMR 1266, INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, France; and
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5
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Dalmage M, LoPresti MA, Sarkar P, Ranganathan S, Abdelmageed S, Pagadala M, Shlobin NA, Lam S, DeCuypere M. Survival and neurological outcomes after stereotactic biopsy of diffuse intrinsic pontine glioma: a systematic review. J Neurosurg Pediatr 2023; 32:665-672. [PMID: 37724839 DOI: 10.3171/2023.7.peds22462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/18/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Diffuse intrinsic pontine gliomas (DIPGs) are aggressive and malignant tumors of the brainstem. Stereotactic biopsy can obtain molecular and genetic information for diagnostic and potentially therapeutic purposes. However, there is no consensus on the safety of biopsy or effect on survival. The authors aimed to characterize neurological risk associated with and the effect of stereotactic biopsy on survival among patients with DIPGs. METHODS A systematic review was performed in accordance with PRISMA guidelines to identify all studies examining pediatric patients with DIPG who underwent stereotactic biopsy. The search strategy was deployed in PubMed, Embase, and Scopus. The quality of studies was assessed using the Grading of Recommendations, Assessment, Development and Evaluation system, and risk of bias was evaluated with the Cochrane Risk of Bias in Nonrandomized Studies-of Interventions tool. Bibliographic, demographic, clinical, and outcome data were extracted from studies meeting inclusion criteria. RESULTS Of 2634 resultant articles, 13 were included, representing 192 patients undergoing biopsy. The weighted mean age at diagnosis was 7.5 years (range 0.5-17 years). There was an overall neurosurgical complication rate of 13.02% (25/192). The most common neurosurgical complication was cranial nerve palsy (4.2%, 8/192), of which cranial nerve VII was the most common (37.5%, 3/8). The second most common complication was perioperative hemorrhage (3.6%, 7/192), followed by hemiparesis (2.1%, 4/192), speech disorders (1.6%, 3/192) such as dysarthria and dysphasia, and movement disorders (1.0%, 2/192). Hydrocephalus was less commonly reported (0.5%, 1/192), and there were no complications relating to wound infection/dehiscence (0%, 0/192) or CSF leak (0%, 0/192). No mortality was specifically attributed to biopsy. Diagnostic yield of biopsy revealed a weighted mean of 97.4% (range 91%-100%). Of the studies reporting survival data, 37.6% (32/85) of patients died within the study follow-up period (range 2 weeks-48 months). The mean overall survival in patients undergoing biopsy was 9.73 months (SD 0.68, median 10 months, range 6-13 months). CONCLUSIONS Children with DIPGs undergoing biopsy have mild to moderate rates of neurosurgical complications and no excessive morbidity. With reasonably acceptable surgical risk and high diagnostic yield, stereotactic biopsy of DIPGs can allow for characterization of patient-specific molecular and genetic features that may influence prognosis and the development of future therapeutic strategies.
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Affiliation(s)
- Mahalia Dalmage
- 1Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Illinois
| | - Melissa A LoPresti
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Prottusha Sarkar
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | | | - Sunny Abdelmageed
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Manasa Pagadala
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Nathan A Shlobin
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Sandi Lam
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
- 5Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Michael DeCuypere
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
- 5Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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Mosteiro A, Hoyos JA, Ferres A, Topczewski T, Rivero A, Rivas A, Aldecoa I, Caballero GA, Morcos R, Balague O, Enseñat J, González JJ. The ghost tumour revisited. Corticosteroids in primary central nervous system lymphoma: diagnostic, prognostic and therapeutic implications. Br J Neurosurg 2023:1-8. [PMID: 37997350 DOI: 10.1080/02688697.2023.2283130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The cytolytic effect of corticosteroids on primary central nervous system lymphoma (PCNSL) has established the clinical dogma of avoiding steroid therapy prior to surgery for diagnostic purposes. However, since steroids are very useful during the initial management of intracranial lesions with vasogenic oedema, it was our aim to determine whether they cause a drawback in the diagnosis and prognosis of PCNSL. METHODS A retrospective cohort study of patients diagnosed with PCNSL between 2000 and 2020 in our tertiary neurosurgical centre. Data on steroid administration, surgery type and complications, haematopathological findings and prognostic factors were compiled. A second cohort was used as a control group to compare the ratio of non-diagnostic biopsies; this series comprised patients who underwent stereotactic brain biopsy for any reason between 2019 and 2020. RESULTS Forty patients with PCNSL were included in the study, of which 28 (70%) had received steroids before surgery. The use of steroids was more prevalent in patients with poorer performance status at diagnosis. No relevant differences were found in the diagnostic accuracy regardless of steroid exposure (93% under steroids vs 100% without steroids) or type of surgery performed. Furthermore, steroid withdrawal did not seem to augment the diagnostic ratio. The notable diagnostic delay was not influenced by the use of steroids. CONCLUSIONS Novel imaging and surgical techniques might obviate the need to withhold corticosteroids from patients suffering from PCNSL prior to biopsy. Moreover, when steroids have been given, tapering them and delaying the surgery might not be justified. This could hold relevant therapeutic implications in the early clinical stages.
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Affiliation(s)
- Alejandra Mosteiro
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jhon A Hoyos
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Abel Ferres
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Thomaz Topczewski
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Andrea Rivero
- Department of Haematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Alfredo Rivas
- Department of Haematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Iban Aldecoa
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Ricardo Morcos
- Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Olga Balague
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jose Juan González
- Department of Neurological Surgery, Hospital Clínic of Barcelona, Barcelona, Spain
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Cohen EO, Weaver O, Korhonen KE, Sun J, Leung JWT. Retrospective Comparison of the Lateral-Arm and Vertical Needle Approaches for Prone Tomosynthesis-Guided Breast Biopsy. Can Assoc Radiol J 2023; 74:755-757. [PMID: 36947722 DOI: 10.1177/08465371231164601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Affiliation(s)
- Ethan O Cohen
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Centre, Houston, TX USA
| | - Olena Weaver
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Centre, Houston, TX USA
| | | | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Centre, Houston, TX USA
| | - Jessica W T Leung
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Centre, Houston, TX USA
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8
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Gerlach KE, Phalak KA, Cohen EO, Chang KN, Bassett R, Whitman GJ. Stepwise Implementation of 2D Synthesized Screening Mammography and Its Effect on Stereotactic Biopsy of Microcalcifications. Diagnostics (Basel) 2023; 13:2232. [PMID: 37443627 DOI: 10.3390/diagnostics13132232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
RATIONALE AND OBJECTIVES Information evaluating the efficacy of 2D synthesized mammography (2Ds) reconstructions in microcalcification detection is limited. This study used stereotactic biopsy data for microcalcifications to evaluate the stepwise implementation of 2Ds in screening mammography. The study aim was to identify whether 2Ds + digital breast tomosynthesis (DBT) is non-inferior to 2D digital mammography (2DM) + 2Ds + DBT, 2DM + DBT, and 2DM in identifying microcalcifications undergoing further diagnostic imaging and stereotactic biopsy. MATERIALS AND METHODS Retrospective stereotactic biopsy data were extracted following 151,736 screening mammograms of healthy women (average age, 56.3 years; range, 30-89 years), performed between 2012 and 2019. The stereotactic biopsy data were separated into 2DM, 2DM + DBT, 2DM + 2Ds + DBT, and 2Ds + DBT arms and examined using Fisher's exact test to compare the detection rates of all cancers, invasive cancers, DCIS, and ADH between modalities for patients undergoing stereotactic biopsy of microcalcifications. RESULTS No statistical significance in cancer detection was seen for 2Ds + DBT among those calcifications that underwent stereotactic biopsy when comparing the 2Ds + DBT to 2DM, 2DM + DBT, and 2DM + 2Ds + DBT imaging combinations. CONCLUSION These data suggest that 2Ds + DBT is non-inferior to 2DM + DBT in detecting microcalcifications that will undergo stereotactic biopsy.
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Affiliation(s)
- Karen E Gerlach
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, USA
| | - Kanchan Ashok Phalak
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, USA
| | - Ethan O Cohen
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, USA
| | - Kiran N Chang
- Department of Radiology, University of Texas Health Science Center, 6431 Fannin St, Houston, TX 77030, USA
| | - Roland Bassett
- Biostatistics Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Gary J Whitman
- Department of Breast Imaging, MD Anderson Cancer Center, 1155 Pressler St. Unit 1350, Houston, TX 77030, USA
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Tuohy K, Ba DM, Bhanja D, Leslie D, Liu G, Mansouri A. Early costs and complications of first-line low-grade glioma treatment using a large national database: Limitations and future perspectives. Front Surg 2023; 10:1001741. [PMID: 36816005 PMCID: PMC9935584 DOI: 10.3389/fsurg.2023.1001741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Diffuse Low-grade gliomas (DLGG, WHO Grade II) are a heterogenous group of tumors comprising 13-16% of glial tumors. While maximal safe resection is endorsed as the best approach to DLGG, compared to more conservative interventions like stereotactic biopsy, the added costs and risks have not been systematically evaluated. The purpose of this study was to better understand the complication rates and costs associated with each intervention. Methods A retrospective cohort study using data from the IBM Watson Health MarketScan® Commercial Claims and Encounters database was conducted, using the International Classification of Diseases, Ninth Revision (ICD-9) codes corresponding to DLGG (2005-2014). Current Procedure Terminology, 4th Edition (CPT-4) codes were used to differentiate resection and biopsy cohorts. Inverse weighting by the propensity score was used to balance baseline potential confounders (age, sex, pre-op seizure, geographic region, year, Charleston Comorbidity Index). Complication rates, hospital mortality, readmission, and costs were compared between groups. Results We identified 5,784 and 3,635 patients undergoing resection and biopsy, respectively, for initial DLGG management. Resection was associated with greater 30-day complications (29.17% vs. 26.34%; p < 0.05). However, this association became non-significant after inverse propensity weighting (adjusted odds ratio = 1.09; 0.98-1.20). There was no statistically significant difference in unadjusted, 30-day hospital mortality (p = 0.06) or re-admission (p = 0.52). Resection was associated with higher 90-day total costs (p < 0.0001) and drug costs (p < 0.0001). Biopsy was associated with greater index procedure costs (p < 0.0001). Long-term outcomes and evaluation of DLGG subtypes was not possible given limitations in the metrics recorded in MarketScan and lack of specificity in the ICD coding system. Conclusion Resection was not associated with an increase in the adjusted complication rate after balancing for baseline prognostic factors. Total costs and drug costs were higher with resection of DLGG, but the index procedure costs were higher for biopsy. This data should help to facilitate prospective health economic analyses in the future to understand the cost-effectiveness, and impact on quality of life, for DLGG interventions. However, the use of large national databases for studying long-term outcomes in DLGG management should be discouraged until there is greater specificity in the ICD coding system for DLGG subtypes.
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Affiliation(s)
- Kyle Tuohy
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, United States,Correspondence: Kyle Tuohy
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State University, University park, PA, United States,Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA, United States
| | - Debarati Bhanja
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, United States
| | - Douglas Leslie
- Department of Public Health Sciences, Penn State University, University park, PA, United States,Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA, United States
| | - Guodong Liu
- Department of Public Health Sciences, Penn State University, University park, PA, United States,Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA, United States
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, United States,Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, PA, United States
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10
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Bianco A, Del Maestro M, Fanti A, Airoldi C, Fleetwood T, Crobeddu E, Cossandi C. Use of fluorescein sodium-assisted intraoperative sample validation to maximize the diagnostic yield of stereotactic brain biopsy: progress toward a new standard of care? J Neurosurg 2023; 138:358-366. [PMID: 36303472 DOI: 10.3171/2022.4.jns212954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In patients with contraindication to open resection, histological diagnosis is obtained through a stereotactic biopsy (SB). Missed diagnoses and sampling errors are important limitations of SB; therefore, various ways have been proposed to increase the diagnostic yield (DY). Intraoperative histopathology can obtain a DY exceeding 98% but with several drawbacks, namely prolonged operative times and logistic concerns. The objective of this study was to evaluate whether intraoperative validation of samples with fluorescein sodium can obtain a high DY with the same ease of use as standard SB. METHODS One hundred three consecutive cases of frameless neuronavigated SB performed at the authors' center from May 2013 to June 2021 were included. Two groups were compared: 46 patients underwent standard nonassisted SB (nSB), and 57 patients underwent fluorescein sodium-assisted SB (fSB). Data were collected retrospectively before 2017 and prospectively thereafter. DY, operative time, and rate of complications were compared between the two groups. The surgical technique for fSB was standardized, and a novel classification system for intraoperative fluorescence findings was developed. RESULTS Statistically significant differences between the two groups were identified. The DY of the fSB group (100%, 95% CI 93.73%-100%) was significantly greater than that of the nSB group (89.13%, 95% CI 80.14%-98.13%) (p = 0.0157). No statistically significant differences were observed in terms of mean operative time (p = 0.7104), intraoperative complications (p = 0.999), or postoperative complications (p = 0.5083). CONCLUSIONS Compared with standard nSB, fSB showed a significantly higher DY and similar surgical time and rate of complications. The ease of use, wide diagnostic spectrum, and low cost make fluorescein sodium preferable to other fluorophores. The present study strengthens the limited data in the literature indicating routine use of fSB. The proposed workflow suggests that fSB should be the standard of care for contrast-enhanced cases. Intraoperative histopathology should be limited to nonenhancing cases, and nSB should be avoided. Future prospective multicenter studies will be useful for further validation of our findings.
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Affiliation(s)
- Andrea Bianco
- 1Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| | - Mattia Del Maestro
- 1Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| | - Andrea Fanti
- 2Department of Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Chiara Airoldi
- 3Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; and
| | - Thomas Fleetwood
- 4Department of Neurology, Maggiore della Carità University Hospital, Novara, Italy
| | - Emanuela Crobeddu
- 1Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| | - Christian Cossandi
- 1Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
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11
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Katzendobler S, Do A, Weller J, Rejeski K, Dorostkar MM, Albert NL, Forbrig R, Niyazi M, Egensperger R, Tonn JC, Baumgarten LV, Quach S, Thon N. The value of stereotactic biopsy of primary and recurrent brain metastases in the era of precision medicine. Front Oncol 2022; 12:1014711. [PMID: 36605448 PMCID: PMC9808072 DOI: 10.3389/fonc.2022.1014711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Brain metastases (BM) represent the most frequent intracranial tumors with increasing incidence. Many primary tumors are currently treated in protocols that incorporate targeted therapies either upfront or for progressive metastatic disease. Hence, molecular markers are gaining increasing importance in the diagnostic framework of BM. In cases with diagnostic uncertainty, both in newly diagnosed or recurrent BM, stereotactic biopsy serves as an alternative to microsurgical resection particularly whenever resection is not deemed to be safe or feasible. This retrospective study aimed to analyze both diagnostic yield and safety of an image-guided frame based stereotactic biopsy technique (STX). Material and methods Our institutional neurosurgical data base was searched for any surgical procedure for suspected brain metastases between January 2016 and March 2021. Of these, only patients with STX were included. Clinical parameters, procedural complications, and tissue histology and concomitant molecular signature were assessed. Results Overall, 467 patients were identified including 234 (50%) with STX. Median age at biopsy was 64 years (range 29 - 87 years). MRI was used for frame-based trajectory planning in every case with additional PET-guidance in 38 cases (16%). In total, serial tumor probes provided a definite diagnosis in 230 procedures (98%). In 4 cases (1.7%), the pathological tissue did not allow a definitive neuropathological diagnosis. 24 cases had to be excluded due to non-metastatic histology, leaving 206 cases for further analyses. 114 patients (49%) exhibited newly diagnosed BM, while 46 patients (20%) displayed progressive BM. Pseudoprogression was seen in 46 patients, a median of 12 months after prior therapy. Pseudoprogression was always confirmed by clinical course. Metastatic tissue was found most frequently from lung cancer (40%), followed by breast cancer (9%), and malignant melanoma (7%). Other entities included gastrointestinal cancer, squamous cell cancer, renal cell carcinoma, and thyroid cancer, respectively. In 9 cases (4%), the tumor origin could not be identified (cancer of unknown primary). Molecular genetic analyses were successful in 137 out of 144 analyzed cases (95%). Additional next-generation sequencing revealed conclusive results in 12/18 (67%) cases. Relevant peri-procedural complications were observed in 5 cases (2.4%), which were all transient. No permanent morbidity or mortality was noted. Conclusion In patients with BM, frame-based stereotactic biopsy constitutes a safe procedure with a high diagnostic yield. Importantly, this extended to discerning pseudoprogression from tumor relapse after prior therapy. Thus, comprehensive molecular characterization based on minimal-invasive stereotactic biopsies lays the foundation for precision medicine approaches in the treatment of primary and recurrent BM.
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Affiliation(s)
- Sophie Katzendobler
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Anna Do
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Kai Rejeski
- Department of Medicine III, Hematology and Oncology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mario M. Dorostkar
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Nathalie L. Albert
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Rupert Egensperger
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Louisa v. Baumgarten
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefanie Quach
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany,*Correspondence: Niklas Thon,
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12
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Krüger MT, Terrapon APR, Hoyningen A, Kim CHO, Lauber A, Bozinov O. Posterior Fossa Approaches Using the Leksell Vantage Frame with a Virtual Planning Approach in a Series of 10 Patients-Feasibility, Accuracy, and Pitfalls. Brain Sci 2022; 12:brainsci12121608. [PMID: 36552068 PMCID: PMC9775269 DOI: 10.3390/brainsci12121608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
Abstract
The open-face design of the Leksell Vantage frame provides many advantages. However, its more rigid, contoured design offers less flexibility than other frames. This is especially true for posterior fossa approaches. This study explores whether these limitations can be overcome by tailored frame placement using a virtual planning approach. The posterior fossa was accessed in ten patients using the Leksell Vantage frame. Frame placement was planned with the Brainlab Elements software, including a phantom-based (virtual) pre-operative planning approach. A biopsy was performed in all patients; in four, additional laser ablation surgery was performed. The accuracy of virtual frame placement was compared to actual frame placement. The posterior approach was feasible in all patients. In one case, the trajectory had to be adjusted; in another, the trajectory was switched from a right- to a left-sided approach. Both cases showed large deviations from the initially planned frame placement. A histopathological diagnosis was achieved in all patients. The new Leksell Vantage frame can be used to safely target the posterior fossa with a high diagnostic success rate and accuracy. Frame placement needs to be well-planned and executed. This can be facilitated using specific software solutions as demonstrated.
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Affiliation(s)
- Marie T. Krüger
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
- Department of Neurosurgery, Cantonal Hospital, 9007 St. Gallen, Switzerland
- Department of Stereotactic and Functional Neurosurgery, University Medical Centre, 79106 Freiburg, Germany
- Correspondence: ; Tel.: +44-7855785271
| | | | | | - Chan-Hi Olaf Kim
- Department of Radiology and Nuclear Medicine, Cantonal Hospital, 9007 St. Gallen, Switzerland
| | - Arno Lauber
- Department of Radiology and Nuclear Medicine, Cantonal Hospital, 9007 St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Cantonal Hospital, 9007 St. Gallen, Switzerland
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13
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Vychopen M, Wach J, Borger V, Schneider M, Eichhorn L, Maciaczyk J, Bara G, Vatter H, Banat M, Hamed M. Patient Safety Comparison of Frameless and Frame-Based Stereotactic Navigation for Brain Biopsy-A Single Center Cohort Study. Brain Sci 2022; 12. [PMID: 36138914 DOI: 10.3390/brainsci12091178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Leksell stereotactic system-based aspiration biopsy is a common procedure in the neurosurgical treatment of deep-seated or multiple brain lesions. This study aimed to evaluate the benefit of frameless biopsy using VarioGuide compared to frame-based biopsy using the Leksell stereotactic system (LSS). We analyzed all brain biopsies using VarioGuide or LSS at our neurooncological Department of Neurosurgery in the University Hospital of Bonn between January 2018 and August 2020. We analyzed demographic data, duration of surgery, size of lesion, localization, and early complications. Uni-variable analyses were carried out on data from both groups. In total, 109 biopsies were compared (40 VarioGuide vs. 69 LSS). Patients with VarioGuide were significant older (74 (62−80) years vs. 67 (57−76) years; p = 0.03) and had a shorter duration of general anesthesia (163 (138−194) min vs. 193 (167−215) min, p < 0.001). We found no significant differences in surgery duration (VarioGuide median 28 min (IQR 20−38); LSS: median 30 min (IQR 25−39); p = 0.1352) or in early complication rates (5% vs. 7%; p = 0.644). A slightly higher false negative biopsy rate was registered in the LSS group (3 vs. 1; p = 0.1347). The size of the lesions also did not differ significantly between the two groups (18.31 ± 26.35 cm3 vs. 12.63 ± 14.62; p = 0.15). Our data showed that biopsies performed using VarioGuide took significantly less time than LSS biopsies and did not differ in complication rates. Both systems offered a high degree of patient safety.
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14
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Hirano Y, Shinya Y, Aono T, Hasegawa H, Kawashima M, Shin M, Takami H, Takayanagi S, Umekawa M, Ikemura M, Ushiku T, Taoka K, Tanaka S, Saito N. The Role of Stereotactic Frame-Based Biopsy for Brainstem Tumors in the Era of Molecular-Based Diagnosis and Treatment Decisions. Curr Oncol 2022; 29:4558-4565. [PMID: 35877220 PMCID: PMC9318548 DOI: 10.3390/curroncol29070360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Stereotactic frame-based brain tumor biopsy (SFB) is a potent diagnostic tool considering its minimal invasiveness, though its diagnostic power and safety for brainstem lesions remain to be discussed. Here, we aimed to examine the usefulness of SFB for brainstem tumors. Twenty-two patients with brainstem tumors underwent 23 SFBs at our institution during 2002–2021. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including surgery-related complications and the diagnostic value. Seven (32%) tumors were located from the midbrain to the pons, eleven (50%) in the pons only, and four (18%) from the pons to the medulla oblongata. The target lesions were in the middle cerebellar peduncles in sixteen procedures (70%), the cerebellum in four (17%), the inferior cerebellar peduncles in two (9%), and the superior cerebellar peduncles in one (4%). A definitive diagnosis was made in 21 patients (95%) at the first SFB. The diagnoses were glioma in seventeen (77%) cases, primary central nervous system lymphoma in four (18%), and a metastatic brain tumor in one (5%). The postoperative complications (cranial nerve palsy in three [13%] cases, ataxia in one [4%]) were all transient. SFB for brainstem tumors yields a high diagnostic rate with a low risk of morbidity.
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Affiliation(s)
- Yudai Hirano
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
- Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-0003, Japan;
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
- Correspondence: (Y.S.); (S.T.); Tel.: +03-5800-8853 (Y.S.)
| | - Toshiya Aono
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Masahiro Shin
- Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-0003, Japan;
| | - Hirokazu Takami
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Shunsaku Takayanagi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Masako Ikemura
- Department of Pathology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (M.I.); (T.U.)
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (M.I.); (T.U.)
| | - Kazuki Taoka
- Department of Hematology and Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;
| | - Shota Tanaka
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
- Correspondence: (Y.S.); (S.T.); Tel.: +03-5800-8853 (Y.S.)
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
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15
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Xu R, Rösler J, Teich W, Radke J, Früh A, Scherschinski L, Onken J, Vajkoczy P, Misch M, Faust K. Correlation of Tumor Pathology with Fluorescein Uptake and MRI Contrast-Enhancement in Stereotactic Biopsies. J Clin Med 2022; 11:3330. [PMID: 35743401 DOI: 10.3390/jcm11123330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
The utilization of fluorescein-guided biopsies has recently been discussed to improve and expedite operative techniques in the detection of tumor-positive tissue, as well as to avoid making sampling errors. In this study, we aimed to report our experience with fluorescein-guided biopsies and elucidate distribution patterns in different histopathological diagnoses in order to develop strategies to increase the efficiency and accuracy of this technique. We report on 45 fluorescence-guided stereotactic biopsies in 44 patients (15 female, 29 male) at our institution from March 2016 to March 2021, including 25 frame-based stereotactic biopsies and 20 frameless image-guided biopsies using VarioGuide®. A total number of 347 biopsy samples with a median of 8 samples (range: 4–18) per patient were evaluated for intraoperative fluorescein uptake and correlated to definitive histopathology. The median age at surgery was 63 years (range: 18–87). Of the acquired specimens, 63% were fluorescein positive. Final histopathology included glioblastoma (n = 16), B-cell non-Hodgkin lymphoma (n = 10), astrocytoma, IDH-mutant WHO grade III (n = 6), astrocytoma, IDH-mutant WHO grade II (n = 1), oligodendroglioma, IDH-mutant and 1p/19q-codeleted WHO grade II (n = 2), reactive CNS tissue/inflammation (n = 4), post-transplantation lymphoproliferative disorder (PTLD; n = 2), ependymoma (n = 1), infection (toxoplasmosis; n = 1), multiple sclerosis (n = 1), and metastasis (n = 1). The sensitivity for high-grade gliomas was 85%, and the specificity was 70%. For contrast-enhancing lesions, the specificity of fluorescein was 84%. The number needed to sample for contrast-enhancing lesions was three, and the overall number needed to sample for final histopathological diagnosis was five. Interestingly, in the astrocytoma, IDH-mutant WHO grade III group, 22/46 (48%) demonstrated fluorescein uptake despite no evidence for gadolinium uptake, and 73% of these were tumor-positive. In our patient series, fluorescein-guided stereotactic biopsy increases the likelihood of definitive neuropathological diagnosis, and the number needed to sample can be reduced by 50% in contrast-enhancing lesions.
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16
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Georgiou IT, Pappa ED, Coclami TE, Kelessis NG. Stereotactic vs open biopsy for non-palpable breast lesions. Their impact on short term quality of life. PSYCHOL HEALTH MED 2021; 28:1126-1132. [PMID: 34933617 DOI: 10.1080/13548506.2021.2019806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Stereotactic biopsy and open biopsy represent useful diagnostic tools of breast lesions. However, both affect the Quality of Life (QoL) in various degrees. We conducted this prospective longitudinal comparative study in order, first to access the impact of these techniques on short-term QoL and second to compare and critically discuss our results with those of literature review. Group A (58 patients) underwent vacuum-assisted stereotactic biopsy and Group B (46 patients) underwent open biopsy. The Health-Related Quality of Life (HRQol) was estimated using the European Quality of Life scale (EuroQol) and the SF-36 (The 36-Item Short-Form Health Status Survey) questionnaires. The stereotactic breast biopsy seems to be more accepted from the patients as it affects quality of life to a lesser extent than open breast biopsy. This difference is mainly attributable to a reduction of physical discomfort and pain.
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Affiliation(s)
- Irini T Georgiou
- Department of Radiology, Saint-Savvas Anticancer Hospital, Athens, Greece
| | - Evelina D Pappa
- Faculty of Social Sciences, Hellenic Open University, Patras, Greece
| | | | - Nickos G Kelessis
- Dir. Surgical Oncology Department, "Metropolitan" Gen. Hospital, Athens, Greece
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17
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He L, He D, Qi Y, Zhou J, Yuan C, Chang H, Wang Q, Li G, Shao Q. Stereotactic Biopsy for Brainstem Lesions: A Meta-analysis with Noncomparative Binary Data. Cancer Control 2021; 28:10732748211059858. [PMID: 34875878 PMCID: PMC8670786 DOI: 10.1177/10732748211059858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objectives To evaluate the diagnostic yield and safety of brainstem stereotactic biopsy
for brainstem lesions. Methods We performed a meta-analysis of English articles retrieved from the PubMed,
Web of Science, Cochrane Library, and APA psycInfo databases up to May 12,
2021. A binary fixed-effect model, the inverse variance method, or a binary
random-effect model, the Dersimonian Laird method, were utilized for pooling
the data. This meta-analysis was registered with INPLASY,
INPLASY202190034. Findings A total of 41 eligible studies with 2792 participants were included. The
weighted average diagnostic yield was 97.0% (95% confidential interval [CI],
96.0-97.9%). The weighted average proportions of temporary complications,
permanent deficits, and deaths were 6.2% (95% CI, 4.5–7.9%), .5% (95% CI,
.2–.8%), and .3% (95% CI, .1–.5%), respectively. The subgroup analysis
indicated a nearly identical weighted average diagnostic yield between
MRI-guided stereotactic biopsy and CT-guided stereotactic biopsy (95.9% vs
95.8%) but slightly increased proportions of temporary complications (7.9%
vs 6.0%), permanent deficits (1.9% vs .2%), and deaths (1.1% vs .4%) in the
former compared to the latter. Moreover, a greater weighted average
diagnostic yield (99.2% vs 97.6%) and lower proportions of temporary
complications (5.1% vs 6.8%) and deaths (.7% vs 1.5%) were shown in the
pediatric patient population than in the adult patient population. Conclusions Brainstem stereotactic biopsy demonstrates striking accuracy plus satisfying
safety in the diagnosis of brainstem lesions. The diagnostic yield,
morbidity, and mortality mildly vary based on the diversity of assistant
techniques and subject populations.
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Affiliation(s)
- Lin He
- Department of Radiotherapy, Tangdu Hospital, 56697Air Force Military Medical University, Xi'an, China
| | - Dongjie He
- Department of Radiotherapy, Tangdu Hospital, 56697Air Force Military Medical University, Xi'an, China
| | - Yuhong Qi
- Department of Radiotherapy, Tangdu Hospital, 56697Air Force Military Medical University, Xi'an, China
| | - Jiejing Zhou
- Department of Radiotherapy, Tangdu Hospital, 56697Air Force Military Medical University, Xi'an, China
| | - Canliang Yuan
- Department of Radiotherapy, Tangdu Hospital, 56697Air Force Military Medical University, Xi'an, China
| | - Hao Chang
- Department of Radiotherapy, Tangdu Hospital, 56697Air Force Military Medical University, Xi'an, China
| | - Qiming Wang
- Department of Radiotherapy, Tangdu Hospital, 56697Air Force Military Medical University, Xi'an, China
| | - Gaiyan Li
- Department of Radiotherapy, Tangdu Hospital, 56697Air Force Military Medical University, Xi'an, China
| | - Qiuju Shao
- Department of Radiotherapy, Tangdu Hospital, 56697Air Force Military Medical University, Xi'an, China
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18
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Furtak J, Śledzińska P, Bebyn MG, Szylberg T, Krajewski S, Birski M, Harat M. Infratentorial Stereotactic Biopsy of Brainstem and Cerebellar Lesions. Brain Sci 2021; 11:1432. [PMID: 34827431 DOI: 10.3390/brainsci11111432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
Stereotactic biopsy of posterior fossa lesions is often regarded as hazardous due to the critical structures in that area. Therefore, the aim of the study was to evaluate the diagnostic accuracy and safety of infratentorial stereotactic biopsy of brainstem or cerebellar lesions and its associations with other clinical, laboratory, and radiological parameters. From January 2000 to May 2021, 190 infratentorial stereotactic biopsies of posterior fossa tumors, including 108 biopsies of brainstem lesions, were performed. Moreover, 63 supratentorial biopsies of cerebral peduncle lesions were analyzed to compare the safety and efficacy of both approaches. Additionally, the presence of antibodies against Toxoplasma gondii and Epstein–Barr Virus (EBV) were documented in 67 and 66 patients, respectively, and magnetic resonance imaging (MRI) scans were evaluated in 114 patients. Only 4% of patients had minor complications and 1.5% had major complications, including one patient who died from intracranial bleeding. Nine (4.7%) biopsies were non-diagnostic. Isocitrate dehydrogenase 1 (IDH1) mutation, 1p/19q codeletion, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status were assessed in 29 patients, and were non-diagnostic in only 3 (10.3%) cases. Patients with high-grade gliomas (HGG) were more frequently seropositive for T. gondii than individuals with low-grade gliomas (LGG; p < 0.001). A total of 27% of HGG and 41% of LGG were non-enhancing on MRI. The infratentorial approach is generally safe and reliable for biopsy of brainstem and cerebellar lesions. In our study, the safety and efficacy of supratentorial biopsy of the cerebral peduncle and infratentorial biopsy of lesions below the cerebral peduncle were comparably high. Moreover, patients with HGG were more frequently seropositive for T. gondii than patients with LGG, and the relationship between toxoplasmosis and gliomagenesis requires further investigation.
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19
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Carnevale JA, Imber BS, Winston GM, Goldberg JL, Ballangrud A, Brennan CW, Beal K, Tabar V, Moss NS. Risk of tract recurrence with stereotactic biopsy of brain metastases: an 18-year cancer center experience. J Neurosurg 2021; 136:1045-1051. [PMID: 34507279 DOI: 10.3171/2021.3.jns204347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic biopsy is increasingly performed on brain metastases (BrMs) as improving cancer outcomes drive aggressive multimodality treatment, including laser interstitial thermal therapy (LITT). However, the tract recurrence (TR) risk is poorly defined in an era defined by focused-irradiation paradigms. As such, the authors aimed to define indications and adjuvant therapies for this procedure and evaluate the BrM-biopsy TR rate. METHODS In a single-center retrospective review, the authors identified stereotactic BrM biopsies performed from 2002 to 2020. Surgical indications, radiographic characteristics, stereotactic planning, dosimetry, pre- and postoperative CNS-directed and systemic treatments, and clinical courses were collected. Recurrence was evaluated using RANO-BM (Response Assessment in Neuro-Oncology Brain Metastases) criteria. RESULTS In total, 499 patients underwent stereotactic intracranial biopsy for any diagnosis, of whom 25 patients (5.0%) underwent biopsy for pathologically confirmed viable BrM, a proportion that increased over the time period studied. Twelve of the 25 BrM patients had ≥ 3 months of radiographic follow-up, of whom 6 patients (50%) developed new metastatic growth along the tract at a median of 5.0 months post-biopsy (range 2.3-17.1 months). All of the TR cases had undergone pre- or early post-biopsy stereotactic radiosurgery (SRS), and 3 had also undergone LITT at the time of initial biopsy. TRs were treated with resection, reirradiation, or observation/systemic therapy. CONCLUSIONS In this study the authors identified a nontrivial, higher than previously described rate of BrM-biopsy tract recurrence, which often required additional surgery or radiation and justified close radiographic surveillance. As BrMs are commonly treated with SRS limited to enhancing tumor margins, consideration should be made, in cases lacking CNS-active systemic treatments, to include biopsy tracts in adjuvant radiation plans where feasible.
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Affiliation(s)
- Joseph A Carnevale
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center.,2Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center; and
| | | | - Graham M Winston
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center.,2Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center; and
| | - Jacob L Goldberg
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center.,2Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center; and
| | - Ase Ballangrud
- 4Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cameron W Brennan
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center
| | | | - Viviane Tabar
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center
| | - Nelson S Moss
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center
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20
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Waked R, Tarhini H, Mansour H, Saliba G, Chehata N, Chedid M, Haddad E, Choucair J. A case series of brain abscesses: an eleven-year retrospective single center study. J Infect Dev Ctries 2021; 15:791-797. [PMID: 34242188 DOI: 10.3855/jidc.12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/06/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION We lack data on the epidemiology and management of brain abscesses in the Middle East. The aim of this study is to report a case series of brain abscesses admitted at a tertiary care center in Lebanon, between January 2008 and December 2018. METHODOLOGY This retrospective study aimed at determining the demographic data, treatment, and correlations between different studied variables with prognosis of patients that received treatment. RESULTS Forty-one patients (30 males) were included with a median age of 37 years (2-85). The analysis showed that the classic triad of fever, headache and neurologic deficit was only present in 12% of patients on admission. The source of infection was contiguous in 36.5%, post surgical in 32%, and distant in 17% of cases. Stereotactic biopsy was performed in 41.5% of patients, and craniotomy in 19.5%. A microorganism was isolated in 63% of patients (26 cases). The most used antibiotics were carbapenems (46%) and glycopeptides (66%). Eighty percent of patient (33) had a good outcome. A worse prognosis was significantly correlated with immunosuppression and multiple cerebral abscesses. CONCLUSIONS Brain abscess remains a relatively rare condition.
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Affiliation(s)
- Rami Waked
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Hassan Tarhini
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hussein Mansour
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gebrael Saliba
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Nabil Chehata
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marie Chedid
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elie Haddad
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jacques Choucair
- Department of Infectious Diseases, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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21
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Furtak J, Rakowska J, Szylberg T, Harat M, Małkowski B, Harat M. Glioma Biopsy Based on Hybrid Dual Time-Point FET-PET/MRI-A Proof of Concept Study. Front Neurol 2021; 12:634609. [PMID: 34046002 PMCID: PMC8144440 DOI: 10.3389/fneur.2021.634609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Neuroimaging based on O-[2-(18F)fluoroethyl]-l-tyrosine (FET)-PET provides additional information on tumor grade and extent compared with MRI. Dynamic PET for biopsy target selection further improves results but is often clinically impractical. Static FET-PET performed at two time-points may be a good compromise, but data on this approach are limited. The aim of this study was to compare the histology of lesions obtained from two challenging glioma patients with targets selected based on hybrid dual time-point FET-PET/MRI. Five neuronavigated tumor biopsies were performed in two difficult cases of suspected glioma. Lesions with (T1-CE) and without contrast enhancement (T1 and T2-FLAIR) on MRI were selected. Dual time-point FET-PET imaging was performed 5–15 min (PET10) and 45–60 min (PET60) after radionuclide injection. The most informative FET-PET/MRI images were coregistered with MRI in time of biopsy planning. Five biopsy targets (three from high uptake and two from moderate uptake FET areas) thought to represent the most malignant sites and tumor extent were selected. Histopathological findings were compared with FET-PET and MRI images. Increased FET uptake in the area of non-CE locations on MRI correlated well with high-grade gliomas localized as far as 3 cm from T1-CE foci. Selecting a target in the motor cortex based on FET kinetics defined by dual time-point PET resulted in a grade IV diagnosis after previous negative biopsies based on MRI. An additional grade III diagnosis was obtained from an area of glioma infiltration with moderate FET uptake (between 1 and 1.25 SUV). These findings seem to show that dual time-point FET-PET-based biopsies can provide additional and clinically useful information for glioma diagnosis. Selection of targets based on dual time-point images may be useful for determining the most malignant tumor areas and may therefore be useful for resection and radiotherapy planning.
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Affiliation(s)
- Jacek Furtak
- Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland
| | - Józefina Rakowska
- Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland
| | - Tadeusz Szylberg
- Department of Pathomorphology, 10th Military Research Hospital, Bydgoszcz, Poland
| | - Marek Harat
- Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland.,Department of Neurosurgery and Neurology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Bogdan Małkowski
- Department of Positron Emission Tomography and Molecular Imaging, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.,Department of Nuclear Medicine, Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland
| | - Maciej Harat
- Department of Oncology and Brachytherapy, Faculty of Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.,Department of Neurooncology and Radiosurgery, Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland
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22
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Kunjummen J, Rodriguez K, Newell MS, Hanley K, Cohen MA. Management of Lobular Neoplasia Found on Core Needle Biopsy Performed for Calcifications Using Precise Radiologic-Pathologic Correlation. AJR Am J Roentgenol 2021; 216:1476-85. [PMID: 33852331 DOI: 10.2214/AJR.19.22599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of our study was to evaluate the upgrade rate of calcified lobular neoplasia (LN) versus incidental noncalcified classic LN found on core needle biopsy performed for the evaluation of suspicious calcifications. MATERIALS AND METHODS. This retrospective study included 390 consecutive image-guided breast core needle biopsies with microcalcifications as the target that were performed between December 2009 and July 2017. In 81 of the 390 core biopsies, the highest-risk lesion was LN that then underwent either excision or imaging follow-up. Core biopsy results were compared with excision and imaging follow-up findings. An upgrade of LN was defined as ductal carcinoma in situ or invasive ductal or lobular carcinoma. RESULTS. Of 81 LN diagnosed on core biopsy performed for calcifications, 16 had calcifications within the LN. Fifteen of these 16 cases underwent surgical excision, and three (3/15, 20.0%) were upgraded on excision. Of the 64 core biopsies showing incidental noncalcified LN with benign concordant entities containing calcifications, 42 underwent surgical excision, and one LN (1/42, 2.4%) was upgraded. Twenty-three total lesions (one calcified LN and 22 noncalcified LN) were followed with imaging rather than excision. No cancers were detected among the follow-up group. One case was deemed to have discordant findings on radiologic-pathologic review and was sent for excision, which showed invasive cancer with tubulolobular and lobular features. CONCLUSION. Women undergoing stereotactic core needle biopsy for calcifications revealing noncalcified incidental classic LN and a benign concordant entity that could explain the presence of the target calcifications have a low risk of upgrade and may be followed with imaging. Surgical excision should be offered to women who have LN with calcifications.
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23
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Zanello M, Roux A, Debacker C, Peeters S, Edjlali-Goujon M, Dhermain F, Dezamis E, Oppenheim C, Lechapt-Zalcman E, Harislur M, Varlet P, Chretien F, Devaux B, Pallud J. Postoperative intracerebral haematomas following stereotactic biopsies: Poor planning or poor execution? Int J Med Robot 2021; 17:e2211. [PMID: 33345461 DOI: 10.1002/rcs.2211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/14/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Postoperative intracerebral haematomas represent a serious complication following stereotactic biopsy. We investigated the possible underlying causes - poor planning or poor execution - of postoperative intracerebral haematomas following stereotactic biopsies. METHODS We performed a technical investigation using a retrospective single-centre consecutive series of robot-assisted stereotactic biopsies for a supratentorial diffuse glioma in adults. Each actual biopsy trajectory was reviewed to search for a conflict with an anatomical structure at risk. RESULTS From 379 patients, 12 (3.2%) presented with a postoperative intracerebral haematoma ≥20 mm on postoperative CT-scan (3 requiring surgical evacuation); 11 of them had available intraoperative imaging (bi-planar stereoscopic teleangiography x-rays at each biopsy site). The actual biopsy trajectory was similar to the planned biopsy trajectory in these 11 cases. In 72.7% (8/11) of these cases, the actual biopsy trajectory was found to contact a structure at risk (blood vessel and cerebral sulcus) and identified as the intracerebral haematoma origin. CONCLUSIONS Robot-assisted stereotactic biopsy is an accurate procedure. Postoperative intracerebral haematomas mainly derive from human-related errors during trajectory planning.
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Affiliation(s)
- Marc Zanello
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Alexandre Roux
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Clément Debacker
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Myriam Edjlali-Goujon
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Frédéric Dhermain
- Département d'Oncologie Radiothérapie, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Edouard Dezamis
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Emmanuèle Lechapt-Zalcman
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Marc Harislur
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Pascale Varlet
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Fabrice Chretien
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Bertrand Devaux
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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24
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Xiang B, Sun Q, He M, Wu W, Lu B, Zhang S, Zhang Z, Yang Y, Li Y, Wu Y, Yao Z, Cheng H, Pan L, Miao Q, Wang Y, Ye H. Successful Diagnoses and Remarkable Metabolic Disorders in Patients With Solitary Hypothalamic Mass: A Case Series Report. Front Endocrinol (Lausanne) 2021; 12:693669. [PMID: 34603197 PMCID: PMC8481775 DOI: 10.3389/fendo.2021.693669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Solitary intracranial hypothalamic mass occurs rarely. The etiological diagnosis of solitary hypothalamus lesion is challenging and often unachievable. Although previous studies indicated that lesions affecting the hypothalamus often cause significant metabolic disorders, few reports about the metabolic disturbances of patients with solitary hypothalamic mass have been reported. METHOD Twenty-five patients with solitary hypothalamus lesions who had been evaluated and treated in Huashan Hospital from January 2010 to December 2020 were retrospectively enrolled. The clinical manifestations, radiological features, endocrine and metabolic disorders, and pathology were analyzed. RESULTS The male to female ratio was 5/20. The median age of onset was 22 (19, 35) years old. The most common initial symptom was polydipsia/polyuria (19/25, 76.0%) and amenorrhea (9/20, 45.0%). A high prevalence of hypopituitarism of different axes was found, with almost all no less than 80%. Central hypogonadism (21/22, 95.5%) and central diabetes insipidus (19/21, 90.5%) were the top two pituitary dysfunctions. Conclusive diagnoses were achieved by intracranial surgical biopsy/resection or stereotactic biopsy in 16 cases and by examining extracranial lesions in 3 cases. The pathological results were various, and the most common diagnoses were Langerhans cell histiocytosis (7/19) and hypothalamitis (5/19). The mean timespan from onset to diagnosis in the 19 cases was 34 ± 26 months. Metabolic evaluations revealed remarkable metabolic disorders, including hyperlipidemia (13/16, 81.3%), hyperglycemia (10/16, 62.5%), hyperuricemia (12/20, 60%), overweight/obesity (13/20, 65.0%), and hepatic adipose infiltration (10/13, 76.6%). CONCLUSION Either surgical or stereotactic biopsy will be a reliable and relatively safe procedure to help to confirm the pathological diagnosis of solitary hypothalamic mass. Metabolic disorders were severe in patients with solitary hypothalamic mass. The management of such cases should cover both the treatment of the primary disease, as well as the endocrine and metabolic disorders.
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Affiliation(s)
- Boni Xiang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Quanya Sun
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Min He
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Wu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Lu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuo Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhaoyun Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yehong Yang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiming Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yue Wu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Haixia Cheng
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Pan
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Gamma Hospital, Fudan University, Shanghai, China
| | - Qing Miao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Hongying Ye, ; Yongfei Wang, ; Qing Miao,
| | - Yongfei Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Hongying Ye, ; Yongfei Wang, ; Qing Miao,
| | - Hongying Ye
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Hongying Ye, ; Yongfei Wang, ; Qing Miao,
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25
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Ponisio MR, McConathy JE, Dahiya SM, Miller-Thomas MM, Rich KM, Salter A, Wang Q, LaMontagne PJ, Guzmán Pérez-Carrillo GJ, Benzinger TLS. Dynamic 18F-FDOPA-PET/MRI for the preoperative evaluation of gliomas: correlation with stereotactic histopathology. Neurooncol Pract 2020; 7:656-667. [PMID: 33312679 DOI: 10.1093/nop/npaa044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background MRI alone has limited accuracy for delineating tumor margins and poorly predicts the aggressiveness of gliomas, especially when tumors do not enhance. This study evaluated simultaneous 3,4-dihydroxy-6-[18F]fluoro-L-phenylalanine (FDOPA)-PET/MRI to define tumor volumes compared to MRI alone more accurately, assessed its role in patient management, and correlated PET findings with histopathology. Methods Ten patients with known or suspected gliomas underwent standard of care surgical resection and/or stereotactic biopsy. FDOPA-PET/MRI was performed prior to surgery, allowing for precise co-registration of PET, MR, and biopsies. The biopsy sites were modeled as 5-mm spheres, and the local FDOPA uptake at each site was determined. Correlations were performed between measures of tumor histopathology, and static and dynamic PET values: standardized uptake values (SUVs), tumor to brain ratios, metabolic tumor volumes, and tracer kinetics at volumes of interest (VOIs) and biopsy sites. Results Tumor FDOPA-PET uptake was visualized in 8 patients. In 2 patients, tracer uptake was similar to normal brain reference with no histological findings of malignancy. Eight biopsy sites confirmed for glioma had FDOPA uptake without T1 contrast enhancement. The PET parameters were highly correlated only with the cell proliferation marker, Ki-67 (SUVmax: r = 0.985, P = .002). In this study, no statistically significant difference between high-grade and low-grade tumors was demonstrated. The dynamic PET analysis of VOIs and biopsy sites showed decreasing time-activity curves patterns. FDOPA-PET imaging directly influenced patient management. Conclusions Simultaneous FDOPA-PET/MRI allowed for more accurate visualization and delineation of gliomas, enabling more appropriate patient management and simplified validation of PET findings with histopathology.
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Affiliation(s)
- Maria R Ponisio
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Jonathan E McConathy
- Department of Radiology, Division of Molecular Imaging and Therapeutics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Sonika M Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Michelle M Miller-Thomas
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Keith M Rich
- Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri
| | - Amber Salter
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - Qing Wang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Pamela J LaMontagne
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | | | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
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26
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Abstract
Most patients with primary central system lymphoma (PCNSL) have immune dysfunction. PCNSL without immune dysfunction is rare and extremely challenging to diagnose. Here, we report the case of a 52-year-old woman without immune dysfunction who presented with PCNSL. The patient died a few months after diagnosis and during treatment. A review of this PCNSL patient's case highlighted that poor interpretation of imaging features and the poor correlation of laboratory test results with clinical findings led to a difficulty in making a diagnosis and administering the best treatment. For an accurate diagnosis of early stage PCNSL, positron-emission tomography computed tomography and corticosteroids should be used cautiously before stereotactic biopsy.
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Affiliation(s)
- Xu Zeng
- Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgery Clinical Medical Research Center of Sichuan Province
- Academician (Expert) Workstation of Sichuan Province
| | - Xiaofei Lu
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xinlong Li
- Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgery Clinical Medical Research Center of Sichuan Province
- Academician (Expert) Workstation of Sichuan Province
| | - Lilei Peng
- Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgery Clinical Medical Research Center of Sichuan Province
- Academician (Expert) Workstation of Sichuan Province
| | - Ligang Chen
- Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Neurosurgery Clinical Medical Research Center of Sichuan Province
- Academician (Expert) Workstation of Sichuan Province
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27
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Zervos TM, Scarpace L, Robin AM, Schwalb JM, Air EL. Adapting to Space Limitations During Prone Real-Time Magnetic Resonance Imaging-Guided Stereotaxic Laser Ablation: Technical Pearls. Oper Neurosurg (Hagerstown) 2020; 18:398-402. [PMID: 31245819 DOI: 10.1093/ons/opz173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/11/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND New techniques of intraoperative magnetic resonance imaging (MRI)-guided stereotaxy enable minimally invasive approaches to intracranial pathology. Laser interstitial thermal therapy (LITT), convection-enhanced drug delivery, and stereotactic biopsy can be performed with a real-time confirmation of location and the ability to adjust for intracranial shift during the procedure. However, these procedures are constrained by patient positioning and the need for trajectories that avoid collision between stereotactic elements and the small MRI bore. To our knowledge, this is the first report to outline the technical details of safe intraoperative MRI (iMRI)-guided stereotaxy, performed with prone positioning. OBJECTIVE To present technical pearls to guide the safe conduction of iMRI-guided stereotaxy and LITT while in the prone position. METHODS The details of the positioning and trajectories for a series of patients who underwent Clearpoint® (MRI Interventions Inc) frameless real-time MRI-guided stereotaxis using a posterior approach were reviewed. RESULTS In this series, 5 patients underwent selective amygdalohippocampectomy, and 2 underwent tumor biopsy/ablation while in the prone position without any complications. CONCLUSION Prone iMRI procedures can be performed safely even in a 60-cm MRI bore.
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Affiliation(s)
- Thomas M Zervos
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Lisa Scarpace
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Adam M Robin
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
| | - Ellen L Air
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan
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28
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Furtak J, Mielczarek M, Szylberg M, Harat M. Biomarker concordance between molecular stereotactic biopsy and open surgical specimens in gliomas. Neurol Neurochir Pol 2019; 53:435-441. [PMID: 31746452 DOI: 10.5603/pjnns.a2019.0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 11/25/2022]
Abstract
AIMS To compare 1p/19q codeletion, MGMT promoter methylation, and IDH mutation status in stereotactic biopsy and open craniotomy specimens. CLINICAL RATIONALE The latest WHO classification of gliomas requires assessment of the expression of molecular markers. Samples can be obtained for molecular assays via open craniotomy or molecular stereotactic biopsy (MSB). However, there is uncertainty as to whether MSB is representative of the entire tumour, and therefore how reliable it is for treatment planning. PATIENTS AND METHODS We examined 11 patients diagnosed with brain tumours suspicious of glioma who underwent open craniotomy after stereotactic biopsy and in whom multiple biomarkers were assessed in both sets of samples by methylation-specific multiplex ligation-dependent probe amplification. Institutional Review Board ethical approval was granted (KB 694/2018). RESULTS The initial histopathological grade as determined by stereotactic biopsy was the same as in the samples obtained by open surgery. Further, the marker profile used here was valid in both high- and low-grade gliomas. CONCLUSION AND CLINICAL IMPLICATION MSB is a reliable way to obtain material for precision medicine approaches.
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Affiliation(s)
- Jacek Furtak
- 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-001 Bydgoszcz, Poland
| | - Maciej Mielczarek
- 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-001 Bydgoszcz, Poland
| | - Mateusz Szylberg
- 10th Military Research Hospital and Polyclinic, Powstańców Warszawy 5, 85-001 Bydgoszcz, Poland
| | - Maciej Harat
- Unit of Radiosurgery and Radiotherapy of CNS Tumors, Department of Radiotherapy, Franciszek Lukaszczyk Memorial Oncology Center, Romanowskiej 2, 85-796 Bydgoszcz, Poland.
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29
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Gates EDH, Yang J, Fukumura K, Lin JS, Weinberg JS, Prabhu SS, Long L, Fuentes D, Sulman EP, Huse JT, Schellingerhout D. Spatial Distance Correlates With Genetic Distance in Diffuse Glioma. Front Oncol 2019; 9:676. [PMID: 31417865 PMCID: PMC6682615 DOI: 10.3389/fonc.2019.00676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/10/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Treatment effectiveness and overall prognosis for glioma patients depend heavily on the genetic and epigenetic factors in each individual tumor. However, intra-tumoral genetic heterogeneity is known to exist and needs to be managed. Currently, evidence for genetic changes varying spatially within the tumor is qualitative, and quantitative data is lacking. We hypothesized that a greater genetic diversity or “genetic distance” would be observed for distinct tumor samples taken with larger physical distances between them. Methods: Stereotactic biopsies were obtained from untreated primary glioma patients as part of a clinical trial between 2011 and 2016, with at least one biopsy pair collected in each case. The physical (Euclidean) distance between biopsy sites was determined using coordinates from imaging studies. The tissue samples underwent whole exome DNA sequencing and epigenetic methylation profiling and genomic distances were defined in three separate ways derived from differences in number of genes, copy number variations (CNV), and methylation profiles. Results: Of the 31 patients recruited to the trial, 23 were included in DNA methylation analysis, for a total of 71 tissue samples (14 female, 9 male patients, age range 21–80). Samples from an 8 patient subset of the 23 evaluated patients were further included in whole exome and copy number variation analysis. Physical and genomic distances were found to be independently and positively correlated for each of the three genomic distance measures. The correlation coefficients were 0.63, 0.65, and 0.35, respectively for (a) gene level mutations, (b) copy number variation, and (c) methylation status. We also derived quantitative linear relationships between physical and genomic distances. Conclusion: Primary brain tumors are genetically heterogeneous, and the physical distance within a given glioma correlates to genomic distance using multiple orthogonal genomic assessments. These data should be helpful in the clinical diagnostic and therapeutic management of glioma, for example by: managing sampling error, and estimating genetic heterogeneity using simple imaging inputs.
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Affiliation(s)
- Evan D H Gates
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, United States
| | - Jie Yang
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, United States.,Department of Radiation Oncology, NYU Langone School of Medicine, New York, NY, United States
| | - Kazutaka Fukumura
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jonathan S Lin
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, United States.,Department of Bioengineering, Rice University, Houston, TX, United States
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lihong Long
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Langone School of Medicine, New York, NY, United States
| | - Jason T Huse
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dawid Schellingerhout
- Departments of Neuroradiology and Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Lynagh R, Ishak M, Georges J, Lopez D, Osman H, Kakareka M, Boyer B, Goldman HW, Eschbacher J, Preul MC, Nakaji P, Turtz A, Yocom S, Appelt D. Fluorescence-guided stereotactic biopsy: a proof-of-concept study. J Neurosurg 2019:1-7. [PMID: 30797218 DOI: 0.3171/2018.11.jns18629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 11/15/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVEAccurate histopathological diagnoses are often necessary for treating neuro-oncology patients. However, stereotactic biopsy (STB), a common method for obtaining suspicious tissue from deep or eloquent brain regions, fails to yield diagnostic tissue in some cases. Failure to obtain diagnostic tissue can delay initiation of treatment and may result in further invasive procedures for patients. In this study, the authors sought to determine if the coupling of in vivo optical imaging with an STB system is an effective method for identification of diagnostic tissue at the time of biopsy.METHODSA minimally invasive fiber optic imaging system was developed by coupling a 0.65-mm-diameter coherent fiber optic fluorescence microendoscope to an STB system. Human U251 glioma cells were transduced for stable expression of blue fluorescent protein (BFP) to produce U251-BFP cells that were utilized for in vitro and in vivo experiments. In vitro, blue fluorescence was confirmed, and tumor cell delineation by fluorescein sodium (FNa) was quantified with fluorescence microscopy. In vivo, transgenic athymic rats implanted with U251-BFP cells (n = 4) were utilized for experiments. Five weeks postimplantation, the rats received 5-10 mg/kg intravenous FNa and underwent craniotomies overlying the tumor implantation site and contralateral normal brain. A clinical STB needle containing our 0.65-mm imaging fiber was passed through each craniotomy and images were collected. Fluorescence images from regions of interest ipsilateral and contralateral to tumor implantation were obtained and quantified.RESULTSLive-cell fluorescence imaging confirmed blue fluorescence from transduced tumor cells and revealed a strong correlation between tumor cells quantified by blue fluorescence and FNa contrast (R2 = 0.91, p < 0.001). Normalized to background, in vivo FNa-mediated fluorescence intensity was significantly greater from tumor regions, verified by blue fluorescence, compared to contralateral brain in all animals (301.7 ± 34.18 relative fluorescence units, p < 0.001). Fluorescence intensity measured from the tumor margin was not significantly greater than that from normal brain (p = 0.89). Biopsies obtained from regions of strong fluorescein contrast were histologically consistent with tumor.CONCLUSIONSThe authors found that in vivo fluorescence imaging with an STB needle containing a submillimeter-diameter fiber optic fluorescence microendoscope provided direct visualization of neoplastic tissue in an animal brain tumor model prior to biopsy. These results were confirmed in vivo with positive control cells and by post hoc histological assessment. In vivo fluorescence guidance may improve the diagnostic yield of stereotactic biopsies.
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Affiliation(s)
- Robert Lynagh
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Mark Ishak
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Joseph Georges
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Danielle Lopez
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Hany Osman
- 2Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts
| | - Michael Kakareka
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Brandon Boyer
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - H Warren Goldman
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- 3Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey; and
| | - Jennifer Eschbacher
- 4Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Mark C Preul
- 4Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Peter Nakaji
- 4Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Alan Turtz
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- 3Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey; and
| | - Steven Yocom
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
- 3Department of Neurosurgery, Cooper University Hospital, Camden, New Jersey; and
| | - Denah Appelt
- 1Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
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31
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Abstract
Over the last decade, advances in molecular and imaging-based biomarkers have induced a more versatile diagnostic classification and prognostic evaluation of glioma patients. This, in combination with a growing therapeutic armamentarium, enables increasingly individualized, risk-benefit-optimized treatment strategies. This path to precision medicine in glioma patients requires surgical procedures to be reassessed within multidimensional management considerations. This article attempts to integrate the surgical intervention into a dynamic network of versatile diagnostic characterization, prognostic assessment, and multimodal treatment options in the light of the latest 2016 World Health Organization (WHO) classification of diffuse brain tumors, WHO grade II, III, and IV. Special focus is set on surgical aspects such as resectability, extent of resection, and targeted surgical strategies including minimal invasive stereotactic biopsy procedures, convection enhanced delivery, and photodynamic therapy. Moreover, the influence of recent advances in radiomics/radiogenimics on the process of surgical decision-making will be touched.
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Affiliation(s)
- Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany,
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany,
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32
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Abstract
Background: The purpose of this study was to determine the relationship between the radiological and histopathological distribution of the cerebral lesions diagnosed with stereotactic biopsy (STB) procedure and its outcomes. Materials and Methods: In the current study, a retrospective analysis of 83 patients that underwent the STB in our clinic from January 2011 to December 2015 was made. T1-weighted contrast-enhanced cranial magnetic resonance imaging examinations were performed on patients on whom Leksell stereotactic frame system was installed. The histopathological and the radiological data derived from the STB procedure were classified. Results: In terms of localization, glial tumor (56.6%) was the most common lesion in all regions, except for the multifocal lesions. Contrary to the common knowledge, lymphoma (14.4%) was found to be the most common lesion among multifocal lesions. The success of obtaining positive STB samples in the current series was 95.2% and the complication rate was 3.6%. Conclusion: Had a routine computed tomography scan been performed on each patient in this series, the number of clinically insignificant small intracerebral hematomas would have probably been higher. Nevertheless, the rate of the STB sampling accuracy and the complication rate were similar to those reported in the relevant literature.
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Affiliation(s)
- Ali Akay
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
| | - Mete Rüksen
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
| | - Sertaç Islekel
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
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33
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Shin K, Teichgraeber D, Martaindale S, Whitman GJ. Tomosynthesis-Guided Core Biopsy of the Breast: Why and How to Use it. J Clin Imaging Sci 2018; 8:28. [PMID: 30147992 PMCID: PMC6085842 DOI: 10.4103/jcis.jcis_10_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/13/2018] [Indexed: 11/05/2022] Open
Abstract
Digital breast tomosynthesis (DBT) has become an important tool in breast imaging. It decreases the call-back rate while increasing the cancer detection rate on screening mammography and is useful for diagnostic examination of noncalcified lesions and for the evaluation of patients presenting with clinical symptoms. Management challenges and dilemmas that are encountered with abnormalities detected on DBT and lacking a sonographic correlate can now be addressed with tomosynthesis-guided core biopsy.
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Affiliation(s)
- Kyungmin Shin
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston TX 77030, USA
| | - Davis Teichgraeber
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston TX 77030, USA
| | - Sarah Martaindale
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston TX 77030, USA
| | - Gary J Whitman
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston TX 77030, USA
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34
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Narloch JL, Farber SH, Sammons S, McSherry F, Herndon JE, Hoang JK, Yin FF, Sampson JH, Fecci PE, Blackwell KL, Kirkpatrick JP, Kim GJ. Biopsy of enlarging lesions after stereotactic radiosurgery for brain metastases frequently reveals radiation necrosis. Neuro Oncol 2018; 19:1391-1397. [PMID: 28472527 DOI: 10.1093/neuonc/nox090] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Stereotactic radiosurgery (SRS) offers excellent local control for brain metastases (BM) with low rates of toxicity. Radiation necrosis (RN) may occur after treatment and is challenging to distinguish from local recurrence (LR). We evaluated enlarging brain lesions following SRS that were subsequently biopsied to differentiate RN versus LR. Methods This study reviewed patients receiving SRS for BM between 2008 and 2012 who underwent a biopsy for suspicion of RN versus LR on MRI. Data collection included demographics, radiation parameters, imaging findings, and post-biopsy pathology. Kaplan-Meier methods determined overall survival. Fisher's exact test assessed for association between lesion biopsy result and variables of interest. Results Thirty-four patients with 35 biopsied BM were included. Lesions were biopsied a median of 8.8 months after SRS. Most patients had primary lung cancer (11; 31.4%). Eleven (31.4%) biopsies were positive for LR and 24 (68.6%) showed RN only. Median overall survival was longer for patients with RN (31.0 mo) than for patients with LR (14.5 mo; P = 0.135). Time from SRS to biopsy was significantly different between RN and LR groups; 10 lesions (52.5%) biopsied ≤9 months after SRS showed LR, whereas 1 lesion (6.3%) biopsied >9 months after SRS showed LR (P = 0.004). For 16 (65.7%) lesions, management was changed or directed by the biopsy results. Conclusions Stereotactic biopsy for accessible enlarging lesions after SRS appears diagnostically valuable in patients with few lesions and changes clinical management. RN should be suspected in patients with an enlarging lesion more than 9 months post-SRS.
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Affiliation(s)
- Jessica L Narloch
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - S Harrison Farber
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Sarah Sammons
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Frances McSherry
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - James E Herndon
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Jenny K Hoang
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Fang-Fang Yin
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - John H Sampson
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Peter E Fecci
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Kimberly L Blackwell
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - John P Kirkpatrick
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Grace J Kim
- Breast Cancer Program, Duke Cancer Institute, Clinical Research Training Program, Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Division of Hematology-Oncology, Department of Medicine, Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Division of Neuroradiology, Department of Radiology, Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
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Abstract
Surgery, stereotactic radiosurgery, radiotherapy, and chemotherapy including novel targeted therapy strategies and any combination thereof as well as supportive care are the key elements for treatment of brain metastases. Goals of microsurgery are to obtain tissue samples for histologic diagnosis (particularly in case of uncertainty about the unknown primary tumor but also in the context of future targeted therapies), to relieve burden from space-occupying effects, to improve local tumor control, and to prolong overall survival. Complete surgical resection improves local tumor control and may even affect overall survival. Stereotactic radiosurgery is an equal effective alternative for metastases up to 3 cm in diameter, especially in highly eloquent or deep seated location. Gross total resection (as defined by immediate postoperative MRI) does not necessarily have to be combined with whole brain radiotherapy (WBRT), at least for patients with good performance status and controlled systemic disease. Particularly in cases of incomplete resections, focal irradiation or radiosurgery of the resection cavity or tumor remnant rather than WBRT may be attempted.
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Affiliation(s)
- Niklas Thon
- Department of Neurosurgery, University of Munich LMU, Munich, Germany
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36
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Das KK, Joseph J, Singh AK, Sharma P, Sardhara J, Bhaisora KS, Mehrotra A, Srivastava AK, Jaiswal S, Sahu RN, Jaiswal AK, Behari S. Capsuloganglionic Germinoma: A Rare Site for Uncommon Childhood Tumor. Asian J Neurosurg 2018; 13:492-495. [PMID: 29682070 PMCID: PMC5898141 DOI: 10.4103/ajns.ajns_284_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Germ cell tumors (GCTs) are rare intracranial tumors with a strong predilection for children. Commonly, these tumors arise either in the suprasellar or the pineal region. The basal ganglia-thalamus complex represents a rare site of nonmidline intracranial GCTs. Such basal ganglionic GCTs have been reported to produce certain interesting clinico-radiological features, the knowledge of which may provide important diagnostic clues preoperatively. We present the case of a 9.5-year-old boy who presented with right hemiparesis and precocious puberty. Imaging revealed a heterogeneously enhancing mass involving the left capsuloganglionic region, sparing the thalamus. There was little perilesional edema and midline shift. Because of the deep location of the mass and a lack of mass effect, a neuronavigation-guided tumor biopsy was performed which unraveled a pure germinoma. The child was referred for adjuvant radiotherapy following an uneventful postoperative course. At the time of writing the report, the child was on radiotherapy and doing well.
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Affiliation(s)
- Kuntal Kanti Das
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Jeena Joseph
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Amit Kumar Singh
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Pradeep Sharma
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Anant Mehrotra
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Sushila Jaiswal
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | | | - Sanjay Behari
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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37
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Liu J, Wang Y, Sun X, Liu S, Yu Z, Ji N, Sun S, Liu Y. Lesions of the central nervous system in leukemia: Pathological and magnetic resonance imaging features at presentation in 14 patients. Oncol Lett 2017; 14:8162-8170. [PMID: 29344259 DOI: 10.3892/ol.2017.7192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/26/2017] [Indexed: 10/18/2022] Open
Abstract
The present study aimed to characterize the specific pathology and magnetic resonance imaging (MRI) findings observed in patients with leukemia with central nervous system (CNS) lesions, and to determine their value in the management of such patients. Lesions of the CNS were observed during and following treatment of leukemia. The data from stereotactic biopsy-proven pathology (12 patients) and MRI examinations (14 patients) were retrospectively evaluated. Proton-magnetic resonance-spectroscopy was performed in three patients. Factors that predisposed to lesions of the CNS were reviewed from the patient medical records. Among the 14 patients, eight had CNS leukemia, four had a CNS infection and two had a neurodegenerative disorder (one leukoencephalopathy and one glial cell hyperplasia). The clinical diagnosis based on clinical symptoms, signs and MRI features was not consistent with the pathological diagnosis in two patients. In one patient, the clinical diagnosis was a CNS infection; however, the patient's pathological diagnosis was CNS leukemia. In the other patient, the clinical diagnosis was CNS leukemia, but the pathological diagnosis was glial cell hyperplasia. CNS lesions in leukemia have a wide range of causes. Apart from the relapse of leukemia in the CNS, there are treatment-associated neurotoxicities and infections that are caused by immunocompromised states. As numerous leukemia-associated CNS lesions are treatable, early diagnosis is essential.
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Affiliation(s)
- Jing Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yaming Wang
- Department of Neurosurgery, Navy General Hospital, Beijing 100048, P.R. China
| | - Xuefei Sun
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Shuo Liu
- Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA
| | - Zhenkun Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, Nanjing Tongren Hospital, Southeast University, Nanjing 211100, P.R. China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Shengjun Sun
- Neuroimaging Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yuanbo Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Hamisch C, Kickingereder P, Fischer M, Simon T, Ruge MI. Update on the diagnostic value and safety of stereotactic biopsy for pediatric brainstem tumors: a systematic review and meta-analysis of 735 cases. J Neurosurg Pediatr 2017. [PMID: 28621573 DOI: 10.3171/2017.2.peds1665] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Recent studies have shed light on the molecular makeup of diffuse intrinsic pontine gliomas and led to the identification of potential treatment targets for these lesions, which account for the majority of pediatric brainstem tumors (pedBSTs). Therefore, stereotactic biopsy-driven molecular characterization of pedBSTs may become an important prerequisite for the management of these fatal brain tumors. The authors conducted a systemic review and meta-analysis to precisely determine the safety and diagnostic success of stereotactic biopsy of pedBSTs. METHODS A systematic search of PubMed, EMBASE, and the Web of Science yielded 944 potentially eligible abstracts. Meta-analysis was conducted on 18 studies (including the authors' own institutional series), describing a total of 735 biopsy procedures for pedBSTs. The primary outcome measures were diagnostic success and procedure-related complications. Pooled estimates were calculated based on the Freeman-Tukey double-arcsine transformation and DerSimonian-Laird random-effects model. Heterogeneity, sensitivity, and meta-regression analyses were also conducted. RESULTS The weighted average proportions across the analyzed studies were 96.1% (95% CI 93.5%-98.1%) for diagnostic success, 6.7% (95% CI 4.2%-9.6%) for overall morbidity, 0.6% (95% CI 0.2%-1.4%) for permanent morbidity, and 0.6% (95% CI 0.2%-1.3%) for mortality. Subgroup analyses at the study level identified no significant correlation between the outcome measures and the distribution of the chosen biopsy trajectories (transfrontal vs transcerebellar), age, year of publication, or the number of biopsy procedures annually performed in each center. CONCLUSION Stereotactic biopsy of pedBSTs is safe and allows successful tissue sampling as a prerequisite for the molecular characterization and the identification of potentially druggable targets toward more individualized treatment concepts to improve the outcome for children harboring such lesions.
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Affiliation(s)
- Christina Hamisch
- Departments of 1 General Neurosurgery.,Center of Integrated Oncology (CIO), University of Cologne; and
| | - Philipp Kickingereder
- Stereotaxy and Functional Neurosurgery, and.,Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Matthias Fischer
- Pediatric Hematology and Oncology, University Hospital of Cologne
| | - Thorsten Simon
- Pediatric Hematology and Oncology, University Hospital of Cologne
| | - Maximilian I Ruge
- Departments of 1 General Neurosurgery.,Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
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Tinkle CL, Orr BA, Lucas JT, Klimo P, Patay Z, Baker SJ, Broniscer A, Qaddoumi I. Rapid and fulminant leptomeningeal spread following radiotherapy in diffuse intrinsic pontine glioma. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26416. [PMID: 28084680 PMCID: PMC5796806 DOI: 10.1002/pbc.26416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/10/2016] [Accepted: 11/25/2016] [Indexed: 11/09/2022]
Abstract
A 4-year-old male presented with rapid-onset cranial nerve palsy and ataxia. Brain magnetic resonance imaging (MRI) revealed a pontine mass lesion with discordant conventional and advanced imaging. A stereotactic core biopsy revealed glioblastoma with immunostaining suggestive of histone H3K27M and TP53 mutation, consistent with diffuse intrinsic pontine glioma. MRI 3 months after radiotherapy revealed extensive new leptomeningeal metastatic disease involving both the supra- and infratentorial brain, as well as the imaged portion of the spine. Tissue procured at the time of needle biopsy has undergone striking in vivo expansion as an orthotopic xenograft.
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Affiliation(s)
- Christopher L. Tinkle
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Brent A. Orr
- Department of Pathology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - John T. Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Paul Klimo
- Department of Neurosurgery, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Zoltan Patay
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Suzanne J. Baker
- Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Alberto Broniscer
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
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Markwardt NA, Stepp H, Franz G, Sroka R, Goetz M, Zelenkov P, Rühm A. Remission spectrometry for blood vessel detection during stereotactic biopsy of brain tumors. J Biophotonics 2017; 10:1080-1094. [PMID: 27714967 DOI: 10.1002/jbio.201600193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
Abstract
Stereotactic biopsy is used to enable diagnostic confirmation of brain tumors and treatment planning. Despite being a well-established technique, it is related to significant morbidity and mortality rates mostly caused by hemorrhages due to blood vessel ruptures. This paper presents a method of vessel detection during stereotactic biopsy that can be easily implemented by integrating two side-view fibers into a conventional side-cutting biopsy needle. Tissue within the needle window is illuminated through the first fiber; the second fiber detects the remitted light. By taking the ratio of the intensities at two wavelengths with strongly differing hemoglobin absorption, blood vessels can be recognized immediately before biopsy sampling. Via ray tracing simulations and phantom experiments, the dependency of the remission ratio R = I578 /I650 on various parameters (blood oxygenation, fiber-to-vessel and inter-fiber distance, vessel diameter and orientation) was investigated for a bare-fiber probe. Up to 800-1200 µm away from the probe, a vessel can be recognized by a considerable reduction of the remission ratio from the background level. The technique was also successfully tested with a real biopsy needle probe on both optical phantoms and ex-vivo porcine brain tissue, thus showing potential to improve the safety of stereotactic biopsy. Dual-wavelength remission measurement for the detection of blood vessels during stereotactic biopsy.
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Affiliation(s)
- Niklas A Markwardt
- Laser-Forschungslabor, LIFE Center, University Hospital of Munich, Munich, Germany
- Department of Urology, University Hospital of Munich, Munich, Germany
| | - Herbert Stepp
- Laser-Forschungslabor, LIFE Center, University Hospital of Munich, Munich, Germany
- Department of Urology, University Hospital of Munich, Munich, Germany
| | - Gerhard Franz
- Department of Applied Sciences and Mechatronics, Munich University of Applied Sciences, Munich, Germany
| | - Ronald Sroka
- Laser-Forschungslabor, LIFE Center, University Hospital of Munich, Munich, Germany
- Department of Urology, University Hospital of Munich, Munich, Germany
| | | | | | - Adrian Rühm
- Laser-Forschungslabor, LIFE Center, University Hospital of Munich, Munich, Germany
- Department of Urology, University Hospital of Munich, Munich, Germany
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Szynglarewicz B, Kasprzak P, Donizy P, Biecek P, Halon A, Matkowski R. Epithelial-mesenchymal transition inducer Snail1 and invasive potential of intraductal breast cancer. J Surg Oncol 2017; 116:696-705. [PMID: 28570750 DOI: 10.1002/jso.24708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Transcription factor Snail1 is a key inducer of epithelial-mesenchymal transition (EMT), a biological process implicated in the cancer progression and metastasis. The aim of the study was to investigate Snail1 expression in DCIS found on breast biopsy and assess its predictive value for the final invasion. METHODS A total of 209 patients with histologically diagnosed pure DCIS entered the study. Snail1 reactivity was evaluated with immunohistochemistry in tumor tissue from stereotactic vacuum-assisted biopsy of suspicious microcalcifications. RESULTS Snail1 staining was observed in 62% of tumors: weak, intermediate, and strong in 27%, 21%, and 14% of lesions, respectively. Positive Snail1 expression was significantly rarer in DCIS presenting as powdery microcalcifications, when compared with crushed stone-like and casting-type and was more common in DCIS with comedonecrosis. Correlation with other features was not significant. None of standard parameters significantly influenced the upgrading rate. In contrast, in uni- and multivariate analysis the risk of postoperative invasion was significantly associated with positive Snail1 immunoreactivity. Moreover, there was a significant stepwise increase of upgrading rate according to Snail1 expression in DCIS cells: weak 9%, intermediate 26%, and strong 55%, respectively. CONCLUSIONS Snail1 can reflect the invasive potential of DCIS and help identify its more aggressive subtypes.
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Affiliation(s)
- Bartlomiej Szynglarewicz
- Breast Unit, Department of Surgical Oncology, Lower Silesia Oncology Center, Wroclaw, Poland.,Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Kasprzak
- Department of Breast Imaging, Lower Silesia Oncology Center, Wroclaw, Poland
| | - Piotr Donizy
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - Przemyslaw Biecek
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Agnieszka Halon
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - Rafal Matkowski
- Breast Unit, Department of Surgical Oncology, Lower Silesia Oncology Center, Wroclaw, Poland.,Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
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42
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Zhang JB, Fu K, Gong R, Liu XM, Chen LD, Zhang YX, Yang GF, Zhang J. Application of stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS in China: Report of 7 cases. Medicine (Baltimore) 2016; 95:e5526. [PMID: 27930545 PMCID: PMC5266017 DOI: 10.1097/md.0000000000005526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE The aim of the study was to evaluate stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS. PATIENT CONCERNS Seven AIDS patients with an intracranial lesion who underwent stereotactic biopsy were included in this retrospective study (4 males and 3 females, 15 to 49 years old). The patients' disease history ranged from 1 month to 1 year. The samples were examined by hematoxylin-eosin (HE) staining and immunohistochemical examination. DIAGNOSES, INTERVENTIONS AND OUTCOMES All patients were successfully sampled, and the histological results showed inflammation in 4 cases, toxoplasma gondii infection in 1 case, astrocytoma in 1 case, and abscess in 1 case. The clinical diagnosis included toxoplasma encephalitis (TE) in 2 cases, cryptococcus encephalitis in 2 cases, cytomegalovirus (CMV) encephalitis in 2 case, tubercular abscess in 1 case, astrocytoma in 1 case, and co-infection of TE with Cryptococcus infection in 1 patient. The clinical diagnosis was made according to the plasma and cerebrospinal fluid (CSF) laboratory testing, the imaging data and the histological findings. The diagnostic yield was 100%, and the post-operation morbidity was 14.3% (1/7) with an asymptomatic haemorrhage and seizure in 1 case. There was no operation-related mortality. Patients were followed up for 6 months to 6 years; 1 case fully recovered, 4 cases significantly improved in symptoms, and 2 died. LESSONS Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patient with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. Due to the broad spectrum of nervous system abnormalities in AIDS, histological findings are very valuable. However, histology is not a unique tool for making a definite diagnosis, whereas the combination of molecular pathology and stereotactic biopsy should play a more important role in the future.
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Affiliation(s)
| | - Kai Fu
- Department of Neurosurgery
| | | | | | | | | | - Gui-fang Yang
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
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43
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Markwardt NA, Haj-Hosseini N, Hollnburger B, Stepp H, Zelenkov P, Rühm A. 405 nm versus 633 nm for protoporphyrin IX excitation in fluorescence-guided stereotactic biopsy of brain tumors. J Biophotonics 2016; 9:901-912. [PMID: 26564058 DOI: 10.1002/jbio.v9.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 05/21/2023]
Abstract
Fluorescence diagnosis may be used to improve the safety and reliability of stereotactic brain tumor biopsies using biopsy needles with integrated fiber optics. Based on 5-aminolevulinic-acid-induced protoporphyrin IX (PpIX) fluorescence, vital tumor tissue can be localized in vivo during the excision procedure to reduce the number of necessary samples for a reliable diagnosis. In this study, the practical suitability of two different PpIX excitation wavelengths (405 nm, 633 nm) was investigated on optical phantoms. Violet excitation at 405 nm provides a 50-fold higher sensitivity for the bulk tumor; this factor increases up to 100 with decreasing fluorescent volume as shown by ray tracing simulations. Red excitation at 633 nm, however, is noticeably superior with regard to blood layers obscuring the fluorescence. Experimental results on the signal attenuation through blood layers of well-defined thicknesses could be confirmed by ray tracing simulations. Typical interstitial fiber probe measurements were mimicked on agarose-gel phantoms. Even in direct contact, blood layers of 20-40 µm between probe and tissue must be expected, obscuring 405-nm-excited PpIX fluorescence almost completely, but reducing the 633-nm-excited signal only by 25.5%. Thus, 633 nm seems to be the wavelength of choice for PpIX-assisted detection of high-grade gliomas in stereotactic biopsy. PpIX signal attenuation through clinically relevant blood layers for 405 nm (violet) and 633 nm (red) excitation.
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Affiliation(s)
- Niklas A Markwardt
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany.
| | - Neda Haj-Hosseini
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Bastian Hollnburger
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany
| | - Herbert Stepp
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany
| | | | - Adrian Rühm
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany
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44
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Markwardt NA, Haj-Hosseini N, Hollnburger B, Stepp H, Zelenkov P, Rühm A. 405 nm versus 633 nm for protoporphyrin IX excitation in fluorescence-guided stereotactic biopsy of brain tumors. J Biophotonics 2016; 9:901-12. [PMID: 26564058 DOI: 10.1002/jbio.201500195] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 05/23/2023]
Abstract
Fluorescence diagnosis may be used to improve the safety and reliability of stereotactic brain tumor biopsies using biopsy needles with integrated fiber optics. Based on 5-aminolevulinic-acid-induced protoporphyrin IX (PpIX) fluorescence, vital tumor tissue can be localized in vivo during the excision procedure to reduce the number of necessary samples for a reliable diagnosis. In this study, the practical suitability of two different PpIX excitation wavelengths (405 nm, 633 nm) was investigated on optical phantoms. Violet excitation at 405 nm provides a 50-fold higher sensitivity for the bulk tumor; this factor increases up to 100 with decreasing fluorescent volume as shown by ray tracing simulations. Red excitation at 633 nm, however, is noticeably superior with regard to blood layers obscuring the fluorescence. Experimental results on the signal attenuation through blood layers of well-defined thicknesses could be confirmed by ray tracing simulations. Typical interstitial fiber probe measurements were mimicked on agarose-gel phantoms. Even in direct contact, blood layers of 20-40 µm between probe and tissue must be expected, obscuring 405-nm-excited PpIX fluorescence almost completely, but reducing the 633-nm-excited signal only by 25.5%. Thus, 633 nm seems to be the wavelength of choice for PpIX-assisted detection of high-grade gliomas in stereotactic biopsy. PpIX signal attenuation through clinically relevant blood layers for 405 nm (violet) and 633 nm (red) excitation.
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Affiliation(s)
- Niklas A Markwardt
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany.
| | - Neda Haj-Hosseini
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Bastian Hollnburger
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany
| | - Herbert Stepp
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany
| | | | - Adrian Rühm
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Munich, Germany
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Abstract
Supratentorial gliomas WHO grade II and III with an oligodendroglial phenotype are highly infiltrative lesions that preferentially originate in lobar location. Open tumor resection represents one of the mainstays of management as beneficial decompressive effects for large space-occupying lesions and oncologically relevant cytoreductive effects from complete resection can be expected. In patients not eligible for safe tumor resection meticulous histological and molecular-genetic evaluation can be obtained from advanced stereotactic biopsy techniques. In this perspective, important aspects of open tumor surgery and stereotactic biopsy are discussed within the context of diagnosis, prognosis and treatment of oligodendrogliomas and oligoastrocytomas WHO grade II and III. Practical considerations are provided in order to integrate the place of surgery into an increasingly personalized management concept. For highly selected patients interstitial brachytherapy is introduced as an alternative surgically performed treatment option.
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Affiliation(s)
- Niklas Thon
- Department of Neurosurgery, Hospital of the University of Munich, Campus Grosshadern, Munich, Germany
| | - Friedrich-Wilhelm Kreth
- Department of Neurosurgery, Hospital of the University of Munich, Campus Grosshadern, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Hospital of the University of Munich, Campus Grosshadern, Munich, Germany
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Iijima K, Hirato M, Miyagishima T, Horiguchi K, Sugawara K, Hirato J, Yokoo H, Yoshimoto Y. Microrecording and image-guided stereotactic biopsy of deep-seated brain tumors. J Neurosurg 2015; 123:978-88. [PMID: 25816085 DOI: 10.3171/2014.10.jns14963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Image-guided stereotactic brain tumor biopsy cannot easily obtain samples of small deep-seated tumor or selectively sample the most viable region of malignant tumor. Image-guided stereotactic biopsy in combination with depth microrecording was evaluated to solve such problems. METHODS Operative records, MRI findings, and pathological specimens were evaluated in 12 patients with small deep-seated brain tumor, in which image-guided stereotactic biopsy was performed with the aid of depth microrecording. The tumors were located in the caudate nucleus (1 patient), thalamus (7 patients), midbrain (2 patients), and cortex (2 patients). Surgery was performed with a frameless stereotactic system in 3 patients and with a frame-based stereotactic system in 9 patients. Microrecording was performed to study the electrical activities along the trajectory in the deep brain structures and the tumor. The correlations were studied between the electrophysiological, MRI, and pathological findings. Thirty-two patients with surface or large brain tumor were also studied, in whom image-guided stereotactic biopsy without microrecording was performed. RESULTS The diagnostic yield in the group with microrecording was 100% (low-grade glioma 4, high-grade glioma 4, diffuse large B-cell lymphoma 3, and germinoma 1), which was comparable to 93.8% in the group without microrecording. The postoperative complication rate was as low as that of the conventional image-guided method without using microelectrode recording, and the mortality rate was 0%, although the target lesions were small and deep-seated in all cases. Depth microrecording revealed disappearance of neural activity in the tumor regardless of the tumor type. Neural activity began to decrease from 6.3 ± 4.5 mm (mean ± SD) above the point of complete disappearance along the trajectory. Burst discharges were observed in 6 of the 12 cases, from 3 ± 1.4 mm above the point of decrease of neural activity. Injury discharges were often found at 0.5-1 mm along the trajectory between the area of decreased and disappeared neural activity. Close correlations between electrophysiological, MRI, and histological findings could be found in some cases. CONCLUSIONS Image-guided stereotactic biopsy performed using depth microrecording was safe, it provided accurate positional information in real time, and it could distinguish the tumor from brain structures during surgery. Moreover, this technique has potential for studying the epileptogenicity of the brain tumor.
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Affiliation(s)
| | | | | | | | | | - Junko Hirato
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Hideaki Yokoo
- Human Pathology, Gunma University Graduate School of Medicine; and
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Wang J, Guo Z, Ma E, Xing D, Qiu BO, Wang Y. Diagnosis and treatment of primary central nervous system lymphoma: A report of nine cases and literature review. Oncol Lett 2015; 9:1795-1801. [PMID: 25789045 PMCID: PMC4356288 DOI: 10.3892/ol.2015.2903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 01/09/2015] [Indexed: 11/05/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare, highly malignant tumor type of the nervous system and is associated with poor prognosis. To investigate the efficacy of current treatment strategies for PCNSL, the present study retrospectively analyzed the clinical and pathological features, imaging results, clinical management, and prognoses of nine patients with PCNSL. Postoperative pathological examination confirmed a diagnosis of lymphoma in all the patients and the adopted treatment regimens were as follows: Stereotactic biopsy in combination with methylprednisolone (MP) and methotrexate (MTX) and/or radiotherapy; craniotomy in combination with dexamethasone or MP and/or radiotherapy; and neuroendoscopic surgery in combination with MP and MTX. The follow-up period was 5-27 months with an average duration of 10.1 months. After the initial three months of follow-up, the clinical symptoms of all the patients were significantly improved, with the tumor disappearing in seven patients and evidently reducing in size in two patients. However, six patients exhibited tumor recurrence, three of whom eventually succumbed to the disease during the follow-up period. Currently, comprehensive treatment strategies based on a combination of stereotactic biopsy, chemotherapy and radiotherapy are recommended for the treatment of PCNSL. However, the effectiveness of these treatments remains unsatisfactory. Thus, future studies are required to investigate methods for improving the efficacy of PCNSL treatment strategies.
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Affiliation(s)
- Jun Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Zongze Guo
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Ermeng Ma
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Deguang Xing
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - B O Qiu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yunjie Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Nishihara M, Takeda N, Harada T, Kidoguchi K, Tatsumi S, Tanaka K, Sasayama T, Kohmura E. Diagnostic yield and morbidity by neuronavigation-guided frameless stereotactic biopsy using magnetic resonance imaging and by frame-based computed tomography-guided stereotactic biopsy. Surg Neurol Int 2014; 5:S421-6. [PMID: 25289174 PMCID: PMC4173323 DOI: 10.4103/2152-7806.140211] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/17/2014] [Indexed: 11/05/2022] Open
Abstract
Background: We compared the diagnostic yield and morbidity by frame-based computed tomography-guided stereotactic biopsy (CTSTB) with Brown-Roberts-Wells (BRW) unit and by neuronavigation-guided frameless stereotactic biopsy (NSTB) using magnetic resonance imaging (MRI). Methods: The subjects’ age range was 15-83 years. CTSTB with BRW unit was performed for 59 tumors (58 cases, 1988-2007). NSTB was performed for 38 tumors (35 cases, 2007-2013) with the needle sheath attached to the head holder. By NSTB, target locations of sampling points and trajectories were confirmed by using MRI. Diffusion tensor imaging-based fiber tractography was used to achieve safe trajectories. STB by using BRW did not visualize the trajectory virtually; however, the planning images for NSTB were able to show the trajectory virtually before the procedure. Results: Histological diagnoses were established for 93 tumors at the first biopsy. The diagnostic yield was 94.9% by CTSTB and 97.4% by NSTB (P = 0.944). The morbidity rate was 5.1% by CTSTB and 0% by NSTB (P = 0.417). The absolute risk reduction was 23.1% by NSTB when the targets were basal ganglia (putamen, globus pallidus) or thalamus. In the cases of glioma for which the targets were basal ganglia (putamen, globus pallidus) or thalamus, the absolute risk reduction by NSTB was 30%. Conclusions: There was no significant difference between CTSTB and NSTB concerning the diagnostic yield and morbidity. However, when the target is the basal ganglia (putamen, globus pallidus) or thalamus and glioma is suspected, NSTB by using MRI with virtual trajectory is preferable to CTSTB concerning morbidity.
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Affiliation(s)
| | - Naoya Takeda
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Tomoaki Harada
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Keiji Kidoguchi
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan
| | | | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Gunawardena D, Tresham J, Hardie M, Phillips M, Wylie E. Suspicious mammographic parenchymal abnormalities that are occult at ultrasonography. J Med Imaging Radiat Oncol 2014; 58:668-73. [PMID: 25088444 DOI: 10.1111/1754-9485.12216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 07/01/2014] [Indexed: 12/14/2022]
Abstract
AIM The study aims to ascertain the significance of ultrasonically occult but mammographically suspicious parenchymal abnormalities, detected at screening mammography. METHOD A retrospective analysis was made on BreastScreen Western Australia data from January 2004 to December 2009. The study group included cases with a mammographic parenchymal abnormality, a negative ultrasound scan and a biopsy under stereotactic guidance. A comparable group of ultrasonically visible carcinomas was used as the control to compare with breast carcinomas in the study sample. RESULTS Study population consisted of 469 cases. Twenty per cent (n = 92) of the cases were breast carcinomas, with invasive ductal carcinoma (non-specified) being the most common histological type. There was a statistically significant increase in ductal carcinoma in situ and mucinous carcinoma within this malignant subgroup. Three per cent (n = 17) of the total cohort were borderline lesions on histology. The other 77% (n = 360) of cases were benign histology on core biopsy; however, one was subsequently diagnosed as an interval breast carcinoma. CONCLUSION Stereotactic-guided core biopsy of a suspicious mammographic parenchymal abnormality is warranted, regardless of a normal ultrasound scan, as up to 20% of these cases could be breast carcinomas.
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Affiliation(s)
- Deepika Gunawardena
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
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Manoj N, Arivazhagan A, Bhat DI, Arvinda HR, Mahadevan A, Santosh V, Devi BI, Sampath S, Chandramouli BA. Stereotactic biopsy of brainstem lesions: Techniques, efficacy, safety, and disease variation between adults and children: A single institutional series and review. J Neurosci Rural Pract 2014; 5:32-9. [PMID: 24741247 PMCID: PMC3985354 DOI: 10.4103/0976-3147.127869] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stereotactic biopsy of brainstem lesions have been performed with varying indications, with most of the literature reporting on children. MATERIALS AND METHODS The present study retrospectively analyzed all cases that underwent stereotactic biopsy for brainstem lesion in both adult and pediatric population between 1994 and 2009 in a single tertiary neurosurgical center. The clinical and radiological features, technique of the procedure, morbidity, diagnostic accuracy, spectrum of diagnosis, and variations in adult and pediatric population were analyzed. RESULTS Eighty-two patients were included in the study. Computed tomography (CT) was used as guidance in 73 (38 children and 35 adults) patients and magnetic resonance imaging (MRI) in 9 (3 children and 6 adults). The biopsy was performed in a procedure room under local anesthesia in most adults, while children required sedation. Glioblastoma comprised 29.3% of all pathologies in children, compared with only 4.9% of the pathologies in adult population (P = 0.007). Tuberculosis was the next major diagnosis (9.8%). In 12 patients, initial biopsy was inconclusive. Following a repeat biopsy in 5 of these patients, a diagnosis was possible for 75/82 (91.5%) patients by STB. The location of the target, the choice of entry, the radiological characteristic of the lesion, enhancement pattern, and age group did not significantly correlate with the occurrence of inconclusive biopsy. Permanent complications occurred in two patients (2.4%). There was no mortality in this series. CONCLUSION Stereotactic biopsy has an important role in brainstem lesions, more significantly in adults, due to wider pathological spectrum. It can be performed safely under local anesthesia through a twist drill craniostomy in most of the adults.
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Affiliation(s)
- N Manoj
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Arivazhagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - D I Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - V Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - S Sampath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B A Chandramouli
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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