Comparison of stereotactic and ultrasound-guided biopsy of solid supratentorial tumor: A preliminary report

Abstract

Introduction:The computed tomography (CT) guided stereotactic biopsy (STB) is considered as method of choice for biopsy of intracranial mass lesions. However, it's disadvantages are frame fixation, time requirement for transportation between CT scan suit to the operation theater with added much higher equipment cost in the relatively resource scarred developing country. Ultrasound-guided biopsy (USGB) is relatively simpler, economical, less time consuming, and real-time procedure.Clinical Materials and Methods:Thirty-seven consecutively admitted patients with supratentorial brain tumors, who underwent biopsy of the lesion using CT compatible stereotactic and ultrasound-guided (USGB) procedure formed cohort of the study. Based on location and size of the lesions, the cases were divided into two groups, superficial and deep. Twenty-two patients underwent ultrasound-guided biopsy and 15 with STB.Results:The diagnostic yield of STB was 93% and 91% for ultrasound-guided biopsy. The mean operation time of STB group was 149.00 min and 94 min for USGB, which was statistically significant. Two cases in each group developed hematoma; however, one case in USGB group needed surgical evacuation. The real-time monitoring detected two hematoma intraoperatively, which were further also confirmed on postoperative CT scan head.Conclusions:The ultrasound-guided biopsy procedure (USGB) was simple, relatively shorter time-consuming procedure and equally efficacious and utilizing economical equipment and can act as a safer alternative to CT STB process for biopsy of the intracranial mass lesion. Furthermore, USGB also provided intra-operative real-time monitoring, which provided clue for close monitoring in the postoperative period after completion of biopsy to look for development of fresh hematoma development not only at the biopsy site but also along the biopsy track and adjoining area. Perhaps, a longer period of ultrasonic monitoring following the procedure would be of greater help to detect hematoma formation, which is one of the most common complications of the biopsy procedure.

Comparison of outcomes of free-hand 2-dimensional ultrasound-guided versus navigated 3-dimensional ultrasound-guided biopsy for supratentorial tumours: a single-institution experience with 125 cases

“…For deep-seated "difficult" lesions, it is likely that the operating surgeon preferred to use NUS due to its theoretical advantages. Again, the results were in accordance to those reported in the literature, with significant hematoma formation in 4%-5% of cases and neurological worsening in 5%-13% of cases [5,11,12]. Using the duplex mode of US for delineation of the vessels, a safe trajectory can be determined for biopsy.…”

“…Based on an extensive search of the literature, to the best of our knowledge, no study has yet compared free-hand 2DUS-guided and navigated 3DUS-guided biopsies. In both groups, the diagnostic yield was comparable (FUS, 93.26%; NUS, 91.67%; overall, 92.8%), and in accordance with previous series of IOUS-guided biopsies in the literature [5,11,12,14]. Allouch et al [5] reported one of the largest series of US-guided biopsies.…”

“…IOUS is a useful cost-effective alternative to intraoperative MRI. Multiple studies have compared IOUS with the standard frame-based and frameless techniques [11-13], and all have highlighted the benefits of US, especially its real-time control.…”

“…They achieved a diagnostic yield of 92%, with representative tissue obtained in 95% of the 100 cases [5]. Satyarthee et al [11] reported a similar yield of 91% in their study of 22 IOUS-guided biopsies. Occasionally, even though the target is correctly reached and the tissue obtained is abnormal, a definitive pathological diagnosis is not possible.…”

“…Allouch et al reported a mean or time of 45 minutes from skin incision to closure [5]. Satyarthee et al [11] and Di Lorenzo et al [12] reported mean times of 94 minutes and 56 minutes, respectively, but did not define operating time. All our patients underwent biopsy under general anaesthesia followed by a small craniotomy (3-4 cm) for biopsy.…”