Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment

Kim, J. E.; Kim, D. G.; Paek, Sun Ha; Jung, Hee Won

doi:10.1007/s00701-003-0048-8

Cited by 117 publications

(113 citation statements)

References 22 publications

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“…In pathology, one common diagnostic event well-suited to this type of analysis is the intraoperative consultation where touch, smear and frozen section preparations have long been used to assist surgical decision making [6][7][8][9] .Neurosurgeons incorporate a neuropathologist's interpretation into the surgical plan through intraoperative consultations on small biopsies 5,6,8,10 . These consultations represent a diagnostic challenge for the neuropathologist that imposes sampling and technical limitations under a relative time constraint.…”

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confidence: 99%

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Sources of Error in Neuropathology Intraoperative Diagnosis

Meyer

Keith-Rokosh

Reddy

et al. 2010

Can. j. neurol. sci.

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Specialists institute a variety of diagnostic audits to identify areas of weakness and to optimize clinical performance [1][2][3][4][5] . In pathology, one common diagnostic event well-suited to this type of analysis is the intraoperative consultation where touch, smear and frozen section preparations have long been used to assist surgical decision making [6][7][8][9] .Neurosurgeons incorporate a neuropathologist's interpretation into the surgical plan through intraoperative consultations on small biopsies 5,6,8,10 . These consultations represent a diagnostic challenge for the neuropathologist that imposes sampling and technical limitations under a relative time constraint. Without the luxury of optimal tissue processing and ancillary tests (special stains, immunohistochemistry, electron microscopy, or molecular techniques) intraoperative ABSTRACT: Objective: The goal of this study was to optimize intraoperative neuropathology consultations by studying trends and sources of diagnostic error. We hypothesized that errors in intraoperative diagnoses would have sampling, technical, and interpretive sources. The study also audited diagnostic strengths, weaknesses and trends associated with increasing experience. We hypothesized that errors would decline and that the accuracy of "qualified" diagnoses would improve with experience. Methods: The pathologist's first 100 cases (P1), second 100 (P2), and most recent 100 (P3, after ten years in practice) formed the data set. Intraoperative diagnoses were scored as correct, minor error or major error using the final diagnosis as the gold-standard. Incorrect diagnoses were re-examined by two reviewers to identify sources of error. Results: Among the 300 cases there were 22 errors with 11 in P1, 9 in P2 and 2 in P3. Sampling contributed to 17 errors (77%), technical factors to 7 (32%) and interpretive factors to 16 (73%). Improvement in diagnostic accuracy between P1 and P2 (p=0.8143), or P2 and P3 (p=0.0582) did not reach significance. However, significant improvement was found between P1 and P3 (p=0.0184). Conclusion: The present study was a practical and informative audit for the pathologist and trainees. It reaffirmed the accuracy of intraoperative neuropathology diagnoses and informed our understanding of sources of error. Most errors were due to a combination of sampling, technical and interpretive factors. A significant improvement in diagnostic proficiency was observed with increasing experience. RÉSUMÉ: Sources d'erreurs dans le diagnostic neuropathologique extemporané.Objectif : Le but de cette étude était d'optimiser les consultations neuropathologiques extemporanées en étudiant les tendances et les sources d'erreurs de diagnostic. Nous avons émis l'hypothèse que les sources d'erreurs de diagnostic extemporané proviennent de l'échantillonnage, de la technique et de l'interprétation. L'étude a également vérifié les forces diagnostiques, les faiblesses et les tendances associées à des niveaux croissants d'expérience. Nous avons émis l'hypothèse que le nombre d'erreurs...

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confidence: 99%

Sources of Error in Neuropathology Intraoperative Diagnosis

Meyer

Keith-Rokosh

Reddy

et al. 2010

Can. j. neurol. sci.

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“…In addition, there was a possibility that initial diagnosis determined after initial biopsy was incorrect, for example, undergrading of high grade tumor, since such an early progression of low grade tumor is unusual, and these made us perform the second biopsy for differential diagnosis. In fact, the diagnostic error of stereotactic biopsy has been reported in 3-49% of cases 2,6,10,12,15,23) . One recent study documented that there was no evidence of hyperintensities on MRI, as might be expected from the radiation therapy during the months after its completion 1) .…”

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confidence: 99%

Rapid Progression of Early Delayed Radiation Effect in Pleomorphic Xanthoastrocytoma

Park

Kang

Lee

et al. 2009

J Korean Neurosurg Soc

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Early delayed radiation effects are known to occur within several months after completing radiotherapy for brain tumors. We present marked changes of magnetic resonance imaging (MRI) scan that occurred one month after radiotherapy in a patient with a pleomorphic xanthoastrocytoma, which was eventually diagnosed as an early delayed radiation effect. Such an early development of dramatic MRI change has not been reported in patients treated with radiotherapy for pleomorphic xanthoastrocytomas.

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“…One study demonstrated nearly 50% variation in diagnosis following brain biopsy, 27% leading to a change in treatment. 1 Sarcoid is associated with increased risk of certain cancers, though this has not been demonstrated for gliomas. 2 …”

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confidence: 99%