Accuracy of stereotactic brain biopsy compared to histopathological results after resection

BACKGROUND: The cornerstone of definitive therapy of cerebral mass lesions is accurate diagnosis. Stereotactic brain biopsy is a commonly used tool for diagnosis of cerebral intra-axial mass lesions with reported high diagnostic yield. OBJECTIVE: The aim of the study was to assess the diagnostic yield and accuracy of stereotactic brain biopsy (SBB) in individuals with intra-axial mass lesions. METHODS: This study comprised 200 individuals (128 males and 72 females) with intra-axial mass lesions (170 single lesions and 30 multiple lesions) with an average age of 52.8 years. Between 2005 and 2014, stereotactic image-guided (126 magnetic resonance imaging (MRI) and 74 computerized tomography (CT)) biopsies for histological verification were done at Department of Neurosurgery, Tanta University Hospital. In 180 patients, the surgery was performed with local anesthetic. In 30 patients, the histopathological results of SBB were compared to resected tissues obtained via craniotomy after SBB. RESULTS: In 197 cases, samples were diagnostic, with a diagnostic yield of 98.5%. The overall rate of biopsy-related morbidity was 1%, with no deaths. The histopathological diagnosis of the two procedures were identical in 25 patients. In three cases, the histopathological findings were somewhat different without affecting patient care. After craniotomy, the diagnosis of stereotactic biopsy was completely revised in two patients. The accuracy was 93.3%. CONCLUSION: Despite the small number of patients who underwent resection, the results of this study showed that SBB of brain masses is a safe and accurate procedure for obtaining sufficient samples for histopathological diagnosis and thus planning the best therapeutic options for patients. The outcome of stereotactic biopsy is largely determined by good communication between the pathologist and the neurosurgeon, to get the best tissue sample possible. It can replace a significant number of open craniotomies for biopsy purposes.