“…Ultimately, 41 articles including 2792 unique patients with brainstem lesions were eligible for the meta-analysis. 1 , 4 , 7 , 8 , 13 , 14 , 16 - 19 , 26 - 56 Figure 1. PRISMA flow diagram of study selection.…”
Section: Resultsmentioning
confidence: 99%
“…Multiple studies have suggested that the diagnostic yield of brainstem stereotactic biopsy with CT guidance is 90.4-100.0% 16,42 and that with MRI guidance is 84.6-100.0%. 37,46 Furthermore, according to different patient cohorts, other studies noted that the diagnostic yields of brainstem stereotactic biopsy in the pediatric and adult patient populations were 84.6-100.0% 28,37 and 80.0-100.0%, 49,55 respectively. The present subgroup analysis signifies a nearly identical diagnostic yield between CT-guided and MRIguided stereotactic biopsy and a 1.6% increment in the weighted average diagnostic yield in the pediatric patient population compared to the adult patient population.…”
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.
“…Ultimately, 41 articles including 2792 unique patients with brainstem lesions were eligible for the meta-analysis. 1 , 4 , 7 , 8 , 13 , 14 , 16 - 19 , 26 - 56 Figure 1. PRISMA flow diagram of study selection.…”
Section: Resultsmentioning
confidence: 99%
“…Multiple studies have suggested that the diagnostic yield of brainstem stereotactic biopsy with CT guidance is 90.4-100.0% 16,42 and that with MRI guidance is 84.6-100.0%. 37,46 Furthermore, according to different patient cohorts, other studies noted that the diagnostic yields of brainstem stereotactic biopsy in the pediatric and adult patient populations were 84.6-100.0% 28,37 and 80.0-100.0%, 49,55 respectively. The present subgroup analysis signifies a nearly identical diagnostic yield between CT-guided and MRIguided stereotactic biopsy and a 1.6% increment in the weighted average diagnostic yield in the pediatric patient population compared to the adult patient population.…”
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.
“…Therefore, it is possible that the samples were not representative of the entire lesion. The report by Quick-Weller et al 8 underlines the importance of taking multiple biopsy samples to allow for the pathologists to perform an examination that results in grading that is representative of the entire lesion.…”
“…Patients were considered eligible if (i) they were able to give written informed consent, (ii) no contraindication for MRI and GBCA was present, (iii) a high-grade glioma was suspected on conventional MRI and (iv) the multidisciplinary tumor board recommended a stereotactic biopsy of the lesion. In view of the specific in-house experience [15] and the literature, we assumed that biopsy would confirm the diagnosis in 95% of the cases, that high-grade glioma would be present in 90% and that we would be able to obtain approximately 10 samples per patient. Using G*Power [16] and presuming an effect size d = 0.5, a significance level α = 0.05 and a power (1 − β) = 0.95, we aimed to analyze at least 210 glioma samples, i.e., 25 patients with evaluable qMRI.…”
Section: Patientsmentioning
confidence: 99%
“…A CT scan was performed and fused to the MRI. The trajectory was calculated using the BrainLab iPlan system and the localization of each specimen was documented as it was taken on this preplanned trajectory [15]. Such frame-based biopsies have an accuracy within the range of 1-2 mm [22].…”
Section: Surgical Procedure Histopathology and Mri Matchingmentioning
Quantitative MRI allows to probe tissue properties by measuring relaxation times and may thus detect subtle changes in tissue composition. In this work we analyzed different relaxation times (T1, T2, T2* and T2′) and histological features in 321 samples that were acquired from 25 patients with newly diagnosed IDH wild-type glioma. Quantitative relaxation times before intravenous application of gadolinium-based contrast agent (GBCA), T1 relaxation time after GBCA as well as the relative difference between T1 relaxation times pre-to-post GBCA (T1rel) were compared with histopathologic features such as the presence of tumor cells, cell and vessel density, endogenous markers for hypoxia and cell proliferation. Image-guided stereotactic biopsy allowed for the attribution of each tissue specimen to its corresponding position in the respective relaxation time map. Compared to normal tissue, T1 and T2 relaxation times and T1rel were prolonged in samples containing tumor cells. The presence of vascular proliferates was associated with higher T1rel values. Immunopositivity for lactate dehydrogenase A (LDHA) involved slightly longer T1 relaxation times. However, low T2′ values, suggesting high amounts of deoxyhemoglobin, were found in samples with elevated vessel densities, but not in samples with increased immunopositivity for LDHA. Taken together, some of our observations were consistent with previous findings but the correlation of quantitative MRI and histologic parameters did not confirm all our pathophysiology-based assumptions.
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