Histological yield

Studies have shown that in 2-15% of cases a pathologic diagnosis is not achieved 1) 2) 3) 4) leaving the physician and the patient uncertain as to the next step. Some studies examined the characteristics that predispose toward a nondiagnostic biopsy, such as nonneoplastic lesions 5) 6).

Pasternak et al. aimed to analyze the contemporary diagnostic yield of stereotactic biopsies, predictors for non-diagnostic biopsies, outcome, and follow-up strategy after non-diagnostic biopsy. They conducted a single-center retrospective study of 311 adult patients undergoing stereotactic biopsies due to a newly diagnosed lesion between 2012 and 2018. Patient data regarding comorbidities, presenting symptoms, imaging features, and non-invasive diagnostic procedures were obtained. The overall diagnostic yield was 86.2% and differed significantly between the various suspected diagnosis groups and was the highest when suspecting primary brain tumor compared with non-neoplastic lesions (91.2% vs. 73.3%, p > 0.001). Predicators for non-diagnostic biopsies were small lesion size, lack of contrast-enhancement, presence of sepsis, or underlying hemato-oncological disease. In case of non-diagnostic biopsy, a re-biopsy was performed in 12 cases, revealing a final diagnosis in 75%. In 16 cases, empiric therapy was started based on the suspected underlying disease. Close follow-up was performed in the remaining 15 cases. They showed that stereotactic biopsy is a safe procedure with reasonable diagnostic yield even for non-neoplastic lesions, when non-invasive diagnostic was inconclusive. In addition, they developed treatment recommendations for cases of non-diagnostic biopsies 7).

1)
Bernays RL, Kollias SS, Khan N, Brandner S, Meier S, Yonekawa Y. Histological yield, complications, and technological considerations in 114 consecutive frameless stereotactic biopsy procedures aided by open intraoperative magnetic resonance imaging. J Neurosurg. 2002;97:354–62.
2)
Fountas KN, Kapsalaki EZ, Smisson HF, 3rd, Hartman LP, Johnston KW, Robinson JS Jr. Results and complications from the use of a frameless stereotactic microscopic navigator system. Stereotact Funct Neurosurg. 1998;71:76–82.
3)
Gralla J, Nimsky C, Buchfelder M, Fahlbusch R, Ganslandt O. Frameless stereotactic brain biopsy procedures using the Stealth Station: Indications, accuracy and results. Zentralbl Neurochir. 2003;64:166–70.
4)
Heper AO, Erden E, Savas A, Ceyhan K, Erden I, Akyar S, Kanpolat Y, et al. An analysis of stereotactic biopsy of brain tumors and nonneoplastic lesions: A prospective clinicopathologic study. Surg Neurol. 2005;64(Suppl 2):S82–88
5)
Kim JE, Kim DG, Paek SH, Jung HW. Stereotactic biopsy for intracranial lesions: Reliability and its impact on the planning of treatment. Acta Neurochir (Wien) 2003;145:547.
6)
Zoeller GK, Benveniste RJ, Landy H, Morcos JJ, Jagid J. Outcomes and management strategies after nondiagnostic stereotactic biopsies of brain lesions. Stereotact Funct Neurosurg. 2009;87:174–81.
7)
Pasternak KA, Schwake M, Warneke N, Masthoff M, Zawy Alsofy S, Suero Molina E, Stummer W, Schipmann S. Evaluation of 311 contemporary cases of stereotactic biopsies in patients with neoplastic and non-neoplastic lesions-diagnostic yield and management of non-diagnostic cases. Neurosurg Rev. 2021 Oct;44(5):2597-2609. doi: 10.1007/s10143-020-01394-0. Epub 2020 Sep 20. Erratum in: Neurosurg Rev. 2021 Aug 28;: PMID: 32951126; PMCID: PMC8490258.