Efficacy of a Second Brain Biopsy for Intracranial Lesions after Initial Negativity

Chabaane, Mohamed; Amelot, Aymeric; Riche, Maximilien; Bielle, Franck; Mokhtari, Karima; Touat, Mehdi; Mathon, Bertrand

doi:10.3988/jcn.2020.16.4.659

Cited by 15 publications

(4 citation statements)

References 38 publications

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“…The rate of final diagnosis established with brain biopsy in ICU patients was high in our series (75.9%) and comparable to that obtained in our control group of non-ICU patients (74.9%) and even with recent studies published in non-ICU patients (6)(7)(8). Furthermore, although 24.1% of the biopsies were noncontributory for a diagnosis, they excluded infectious diseases or malignancies, thereby enabling therapeutic management to be adapted accordingly (20)(21)(22)(23). Since the mid-2010s, the progress of metagenomic next-generation sequencing on brain samples has enabled diagnoses that could not be achieved with usual microbiological analyses.…”

Section: Discussionmentioning

confidence: 99%

Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

Mathon

Favreau

Degos

et al. 2022

Critical Care Medicine

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Brain biopsy is a useful surgical procedure in the management of patients with suspected neoplastic lesions. Its role in neurologic diseases of unknown etiology remains controversial, especially in ICU patients. This study was undertaken to determine the feasibility, safety, and the diagnostic yield of brain biopsy in critically ill patients with neurologic diseases of unknown etiology. We also aimed to compare these endpoints to those of non-ICU patients who underwent a brain biopsy in the same clinical context. DESIGN: Monocenter, retrospective, observational cohort study. SETTING:A French tertiary center. PATIENTS:All adult patients with neurologic diseases of unknown etiology under mechanical ventilation undergoing in-ICU brain biopsy between January 2008 and October 2020 were compared with a cohort of non-ICU patients. INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Among the 2,207 brain-biopsied patients during the study period, 234 biopsies were performed for neurologic diseases of unknown etiology, including 29 who were mechanically ventilated and 205 who were not ICU patients. Specific histological diagnosis and final diagnosis rates were 62.1% and 75.9%, respectively, leading to therapeutic management modification in 62.1% of cases. Meningitis on prebiopsy cerebrospinal fluid analysis was the sole predictor of obtaining a final diagnosis (2.3 [1.4-3.8]; p = 0.02). ICU patients who experienced therapeutic management modification after the biopsy had longer survival (p = 0.03). The grade 1 to 4 (mild to severe) complication rates were: 24.1%, 3.5%, 0%, and 6.9%, respectively. Biopsyrelated mortality was significantly higher in ICU patients compared with non-ICU patients (6.9% vs 0%; p = 0.02). Hematological malignancy was associated with biopsy-related mortality (1.5 [1.01-2.6]; p = 0.04). CONCLUSIONS:Brain biopsy in critically ill patients with neurologic disease of unknown etiology is associated with high diagnostic yield, therapeutic modifications and postbiopsy survival advantage. Safety profile seems acceptable in most patients. The benefit/risk ratio of brain biopsy in this population should be carefully weighted.

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Section: Discussionmentioning

confidence: 99%

Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

Mathon

Favreau

Degos

et al. 2022

Critical Care Medicine

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“…One of the main risks of stereotactic biopsy is to provide a sample that is non-contributory to a diagnosis. In a case series of patients with brain tumors, the rate of negative biopsies is close to 5%, exposing the patient to a second biopsy with potential morbidity and additional health care costs [ 8 , 20 , 53 ]. In patients biopsied for cryptogenic neurological disease, this rate reaches 30% [ 3 , 36 – 38 ].…”

Section: Innovations To Increase Biopsy Diagnostic Yieldmentioning

confidence: 99%

“…Complications following a brain biopsy are rare, but like all neurosurgical procedures, they carry some risks, such as seizures, brain edema, or infection [ 52 ]. The most specific and frequent complications related to this procedure are negative sampling, requiring a second biopsy procedure [ 8 ], and brain hemorrhage with potentially serious consequences [ 53 ]. In a mission to become safer and more effective, constant innovations are being made in this field of neurosurgery.…”

Section: Introductionmentioning

confidence: 99%

Advances, technological innovations, and future prospects in stereotactic brain biopsies

Bex

Mathon

2022

Neurosurg Rev

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Stereotactic brain biopsy is one of the most frequently performed brain surgeries. This review aimed to expose the latest cutting-edge and updated technologies and innovations available to neurosurgeons to safely perform stereotactic brain biopsy by minimizing the risks of complications and ensuring that the procedure is successful, leading to a histological diagnosis. We also examined methods for improving preoperative, intraoperative, and postoperative workflows. We performed a comprehensive state-of-the-art literature review. Intraoperative histology, fluorescence, and imaging techniques appear as smart tools to improve the diagnostic yield of biopsy. Constant innovations such as optical methods and augmented reality are also being made to increase patient safety. Robotics and integrated imaging techniques provide an enhanced intraoperative workflow. Patients’ management algorithms based on early discharge after biopsy optimize the patient’s personal experience and make the most efficient possible use of the available hospital resources. Many new trends are emerging, constantly improving patient care and safety, as well as surgical workflow. A parameter that must be considered is the cost-effectiveness of these devices and the possibility of using them on a daily basis. The decision to implement a new instrument in the surgical workflow should also be dependent on the number of procedures per year, the existing stereotactic equipment, and the experience of each center. Research on patients’ postbiopsy management is another mandatory approach to enhance the safety profile of stereotactic brain biopsy and patient satisfaction, as well as to reduce healthcare costs.

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“… 3 , 4 However, the likelihood of definitive tissue diagnosis decreases with smaller tumors or tumors with significant regional histologic heterogeneity. 5 In cases where tissue diagnosis is not achieved in the first procedure, a second SNB achieved definitive diagnosis in 90% of the cases, 6 suggesting technical challenges associated with SNB rather than the intrinsic properties of the lesion as the underlying cause for diagnostic failures. While the likelihood of procedural complication is low, with reported postoperative morbidity generally <10%, 7 , 8 the likelihood of complication increases with the number of samples taken, 9 with the number of trajectories to the lesion, 10 and for lesions in the eloquent cerebrum or deep gray matter/brainstem.…”

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confidence: 99%

Comparison meta-analysis of intraoperative MRI-guided needle biopsy versus conventional stereotactic needle biopsies

Dhawan,

Chen

2023

Neuro-Oncology Advances

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Background MRI-guided needle biopsy (INB) is an emerging alternative to conventional frame-based or frameless stereotactic needle biopsy (SNB). Studies of INB have been limited to select case series, and comparative studies between INB and SNB remain a missing gap in the literature. We performed a meta-analysis to compare INB and SNB literature in terms of diagnostic yield, surgical morbidity and mortality, tumor size and procedural time. Methods We identified 36 separate cohorts in 26 studies of SNB (including both frameless and frame-based biopsies, 3374 patients) and 27 studies of INB (977 patients). Meta-regression and meta-analysis by proportions were performed. Results Relative to publications that studied SNB, publications studying INB more likely involved brain tumors located in the eloquent cerebrum (79.4% versus 62.6%, p=0.004) or are smaller in maximal diameter (2.7 cm in INB group versus 3.6 cm in the SNB group, p =0.032). Despite these differences, the pooled estimate of diagnostic yield for INB was higher than SNB (95.4% versus 92.3%, p=0.026). The pooled estimate of surgical morbidity was higher in the SNB group (12.0%) relative to the INB group (6.1%) (p=0.004). Mortality after the procedure was comparable between INB and SNB (1.7% versus 2.3%, p=0.288). Procedural time was statistically comparable at 90.3 minutes (INB) and 103.7 minutes (SNB), respectively (p=0.526). Conclusions Our meta-analysis indicates that, relative to SNB, INB is more often performed for the challenging, smaller-sized brain tumors located in the eloquent cerebrum. INB is associated with lower surgical morbidity and improved diagnostic yield.

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Efficacy of a Second Brain Biopsy for Intracranial Lesions after Initial Negativity

Cited by 15 publications

References 38 publications

Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

Advances, technological innovations, and future prospects in stereotactic brain biopsies

Comparison meta-analysis of intraoperative MRI-guided needle biopsy versus conventional stereotactic needle biopsies

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