Utility of Brain Biopsy in Patients With Acquired Immunodeficiency Syndrome Before and After Introduction of Highly Active Antiretroviral Therapy

Rosenow, Joshua M.; Hirschfeld, Alan

doi:10.1227/01.neu.0000279733.28768.ff

Cited by 43 publications

(38 citation statements)

References 46 publications

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“…This coagulation protocol was not employed in other studies. Rosenow and Hirschfeld9 considered such coagulation prophylaxis unnecessary as long as thrombocytopenia was corrected (platelets >100 000) prior to biopsy. Both cohorts consisted of AIDS patients.…”

Section: Discussionmentioning

confidence: 99%

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Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

Lee

Bai

Zou

et al. 2016

J Neurol Neurosurg Psychiatry

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Early brain biopsy may be indicated in HIV patients with focal brain lesion. This study aimed to evaluate and compare the safety and diagnostic value of brain biopsy in HIV patients in the pre-highly active antiretroviral therapy (HAART) versus post-HAART era via meta-analysis. Appropriate studies were identified per search criteria. The local database was retrospectively reviewed to select a similar patient cohort. Patient demographics, brain biopsy technique, histopathology and patient outcomes were extracted from each study. Study-specific outcomes were combined per random-effects model. Outcomes were compared between the pre-HAART and post-HAART era. Correlations between outcomes and baseline characteristics were assessed via meta-regression analysis. The proportions of histopathological diagnosis were tabulated and compared between the pre- and post-HAART era. Survival analysis was performed for patients in the post-HAART era. A total of 26 studies (including the local database) with 1209 patients were included in this meta-analysis. The most common indications for brain biopsy were diagnosis unlikely to be toxoplasmosis (n=8, 42.1%), focal brain lesion (n=5, 26.3%) or both (n=3, 15.8%). The weighted proportions for diagnostic success were 92% (95% CI 90.0% to 93.8%), change in management 57.7% (45.9% to 69.1%) and clinical improvement 36.6% (26.3% to 47.5%). Morbidity and mortality were 5.7% (3.6% to 8.3%) and 0.9% (0.3% to 1.9%), respectively. Diagnostic success rate was significantly higher in the post-HAART than the pre-HAART era (97.5% vs 91.9%, p=0.047). The odds ratio (OR) for diagnostic success in patients with contrast-enhanced lesions was 2.54 ((1.25 to 5.15), p<0.01). The median survival for HIV patients who underwent biopsy in the post-HAART era was 225 days (90-2446). Brain biopsy in HIV patients is safe with high diagnostic yield. Early brain biopsy should be considered in patients without classic presentation of toxoplasmosis encephalitis.

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Section: Discussionmentioning

confidence: 99%

“…However, a delay in appropriate treatment can significantly impact patient outcome. Therefore, some studies have advocated early brain biopsy for patients without classic presentation of toxoplasmosis encephalitis (TE) 8 9…”

Section: Introductionmentioning

confidence: 99%

Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

Lee

Bai

Zou

et al. 2016

J Neurol Neurosurg Psychiatry

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“…Therefore, one may conclude that reducing the number of SBs performed in immunocompromised patients will improve the overall yield of the technique. Several groups of researchers have devised algorithms to deduce when a histopathological specimen may be required to make the diagnosis of intracranial lesions in AIDS patients (effectively limiting biopsies in patients who may respond to empiric medical and radiation treatment based on the results of SPECT imaging for lymphoma and of CSF and serology tests for antibodies to opportunistic pathogens), with one group reporting improvement in rapid therapy delivery in their patients and a reduction in the number of biopsies performed at their institution over the last decade [10,11] . The reason for the lower diagnostic yield of SBs in AIDS patients is largely unknown.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Management Strategies after Nondiagnostic Stereotactic Biopsies of Brain Lesions

Zoeller¹,

Benveniste²,

Landy³

et al. 2009

Stereotact Funct Neurosurg

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Background/Aims: A significant minority of stereotactic biopsies (SBs) of brain lesions is nondiagnostic, yet there are no optimal strategies for preventing nondiagnostic SB (NDSB) and for managing patients after NDSB. We performed this study in order to identify risk factors for NDSB, to determine how diagnoses are eventually reached in these patients, and to ascertain whether NDSB affects clinical outcomes. Methods: Retrospective chart review of patients at our institution who underwent SB of brain lesions. Results: Twenty-four out of 100 SBs were nondiagnostic. NDSB was less likely in contrast-enhancing brain lesions in immunocompetent patients, with larger lesions and in the setting of diagnostic findings on intraoperative frozen section analysis. Of 16 patients with adequate postoperative follow-up, a diagnosis was eventually reached in 11, via further review of the pathology, retrieval of additional tissue specimens or additional noninvasive testing. Survival times for patients with NDSB and eventual tumor diagnoses were within expected ranges for patients with similar tumors. Three of the 5 patients who never received a final diagnosis enjoyed prolonged survival without progressive symptoms. Conclusions: Surgeons should consider taking additional specimens in the case of nondiagnostic intraoperative frozen section during SB. If a tumor is suspected and final pathology is nondiagnostic, outside review of the slides may be helpful, and sampling further tissue should be considered. For diseases other than tumors, the diagnosis will generally be made without a repeat biopsy. The delays in diagnosis resulting from NDSB do not appear to affect survival, at least in patients eventually found to have brain tumors.

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“…with focal brain lesions 11,12,16 . However, definitive diagnosis is not reached in as many as 8-10% of patients who undergo brain biopsy 11 . Since tuberculomas are usually firm masses, the blunt probe used in stereotactic biopsies may be pushed away, leading to sampling errors 2 .…”

Section: Discussionmentioning

confidence: 99%

Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient

Pellegrino

Gerhardt

Porfirio

et al. 2010

Rev. Inst. Med. trop. S. Paulo

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Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected patients in developing countries. We report the case of a 34-year old woman co-infected with HIV and possible disseminated tuberculosis (hepatitis, lymphadenopathy, and pleural effusion) who presented a large and solitary intracranial mass lesion. Despite extensive diagnostic efforts, including brain, ganglionar, and liver biopsies, no definitive diagnosis was reached. However, a trial with first-line antituberculous drugs led to a significant clinical and radiological improvement. Atypical presentations of cerebral tuberculomas should always be considered in the differential diagnosis of intracranial mass lesions in HIV-infected patients and a trial with antituberculous drugs is a valuable strategy to infer the diagnosis in a subset of patients.

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Utility of Brain Biopsy in Patients With Acquired Immunodeficiency Syndrome Before and After Introduction of Highly Active Antiretroviral Therapy

Cited by 43 publications

References 46 publications

Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

Outcomes and Management Strategies after Nondiagnostic Stereotactic Biopsies of Brain Lesions

Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient

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