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Neurosurgery Apr 2023Robot-assisted stereotactic biopsy is evolving: 3-dimensional intraoperative imaging tools and new frameless registration systems are spreading. (Observational Study)
Observational Study
BACKGROUND
Robot-assisted stereotactic biopsy is evolving: 3-dimensional intraoperative imaging tools and new frameless registration systems are spreading.
OBJECTIVE
To investigate the accuracy and effectiveness of a new stereotactic biopsy procedure.
METHODS
Observational, retrospective analysis of consecutive robot-assisted stereotactic biopsies using the Neurolocate (Renishaw) frameless registration system and intraoperative O-Arm (Medtronic) performed at a single institution in adults (2019-2021) and comparison with a historical series from the same institution (2006-2016) not using the Neurolocate nor the O-Arm.
RESULTS
In 100 patients (55% men), 6.2 ± 2.5 (1-14) biopsy samples were obtained at 1.7 ± 0.7 (1-3) biopsy sites. An histomolecular diagnosis was obtained in 96% of cases. The mean duration of the procedure was 59.0 ± 22.3 min. The mean distance between the planned and the actual target was 0.7 ± 0.7 mm. On systematic postoperative computed tomography scans, a hemorrhage ≥10 mm was observed in 8 cases (8%) while pneumocephalus was distant from the biopsy site in 76%. A Karnofsky Performance Status score decrease ≥20 points postoperatively was observed in 4%. The average dose length product was 159.7 ± 63.4 mGy cm. Compared with the historical neurosurgical procedure, this new procedure had similar diagnostic yield (96 vs 98.7%; P = .111) and rate of postoperative disability (4.0 vs 4.2%, P = .914) but was shorter (57.8 ± 22.9 vs 77.8 ± 20.9 min; P < .001) despite older patients.
CONCLUSION
Robot-assisted stereotactic biopsy using the Neurolocate frameless registration system and intraoperative O-Arm is a safe and effective neurosurgical procedure. The accuracy of this robot-assisted surgery supports its effectiveness for daily use in stereotactic neurosurgery.
Topics: Adult; Male; Humans; Female; Stereotaxic Techniques; Brain Neoplasms; Robotics; Imaging, Three-Dimensional; Retrospective Studies; Feasibility Studies; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Biopsy
PubMed: 36700740
DOI: 10.1227/neu.0000000000002294 -
Journal of Medical Imaging and... Feb 2023Breast Screen Australia and Breast Screen Aotearoa guidelines recommend breast biopsy marker (BBM) use in indicated patients. This study aims to evaluate breast biopsy...
INTRODUCTION
Breast Screen Australia and Breast Screen Aotearoa guidelines recommend breast biopsy marker (BBM) use in indicated patients. This study aims to evaluate breast biopsy practice and BBM utilisation by modality.
METHODS
An online survey was disseminated to radiologists who identified 'breast imaging' as their area of practice in the Royal Australian and New Zealand College of Radiologists (RANZCR) customer relationship management system. Survey questions addressed participant demographics and factors relating to BBM use.
RESULTS
Most respondents (72%) place between 1 and 4 BBMs per week. Almost all (99%) respondents perform ultrasound-guided biopsy of the breast or axillary nodes, with 85% performing stereotactic or tomosynthesis-guided breast biopsy and 27% performing MRI-guided breast biopsy. BBM utilisation differs by modality, with 97% respondents always placing a BBM post-MRI-guided breast biopsy, 50% always placing a BBM post-stereotactic-guided biopsy and 3% always placing a BBM post-ultrasound-guided breast biopsy.
CONCLUSIONS
Almost all radiologists perform breast biopsy using ultrasound, stereotactic/tomosynthesis or MRI guidance. BBM utilisation varies by modality, with 72% of respondents placing between 1 and 4 clips per week. Reasons for placing or not placing BBM aligned with prior studies. This is the first study to evaluate the number of breast biopsies performed by radiologists on a weekly or monthly basis, providing a useful platform for comparison in the local setting.
Topics: Humans; Female; Australia; Breast; Thorax; Image-Guided Biopsy; Radiologists; Breast Neoplasms; Biopsy
PubMed: 35754114
DOI: 10.1111/1754-9485.13451 -
World Neurosurgery Jun 2017Stereotactic biopsy is an everyday procedure implemented in numerous neurosurgical departments. The procedure is performed to obtain tumor tissue of unclear diagnosis....
OBJECTIVE
Stereotactic biopsy is an everyday procedure implemented in numerous neurosurgical departments. The procedure is performed to obtain tumor tissue of unclear diagnosis. Going in hand with low complication rates and high diagnostic yield, stereotactic biopsies can be performed in adults and children likewise for histopathologic evaluation of lesions in eloquent localizations. However, little is known about whether aged patients do benefit from stereotactic biopsy or rather the therapy that is derived from histopathologic results. In this study, we therefore focused on old (80-84 years) and very old patients (85 years and older) to evaluate whether stereotactic biopsy should be performed leading to further therapy. We also assessed the complication rates of the procedure in this aged population.
METHODS
We performed a retrospective analysis of our database and included all patients older than 80 years who underwent stereotactic biopsy at our department from October 2005 until May 2016. Forty-seven patients were included in this study. These patients were divided into 2 subgroups: group 1 consisted of patients from 80 to 84 years old and group 2 of patients aged 85 years and older. All patients underwent stereotactic biopsy to establish histopathologic diagnosis. We excluded patients who underwent cyst puncture or puncture of a hemorrhage because the procedure was not performed for diagnostic purposes. We assessed gender, neuroradiologic diagnosis, Karnofsky Performance Score (KPS), number of tissue samples taken, histopathologic diagnosis, localization, postoperative hemorrhage, modality of anesthesia anticoagulation, and further therapy.
RESULTS
Group 1 consisted of 34 patients and group 2 of 13 patients. KPS was 80 and 70, respectively. A histopathologic diagnosis was possible in all but 1 patient. In group 1, 61.8% of the patients agreed to further postoperative therapy (radiation, 35.3%; chemotherapy, 11.8%; combined radiochemotherapy, 11.8%; complication that prevented therapy, 2.9%), as did 53.8% of the patients in group 2 (resection, 7.7%; radiation, 15.4%; combined radiochemotherapy, 30.7%). In group 1, 38.2% declined further therapy, as did 64.1% in group 2.
CONCLUSIONS
Also in old and very old patients, a final histopathologic diagnosis should be established to provide adequate therapy. Our data show that most of these aged patients want to be treated.
Topics: Aged, 80 and over; Biopsy; Brain Neoplasms; Databases, Factual; Female; Humans; Karnofsky Performance Status; Male; Retrospective Studies; Stereotaxic Techniques; Time Factors; Tomography Scanners, X-Ray Computed
PubMed: 28344180
DOI: 10.1016/j.wneu.2017.03.059 -
Clinical Imaging 2019Prior to stereotactic breast biopsy, some radiologists obtain a mammogram image with an overlying alphanumeric grid to mark the skin overlying the target. Our purpose is...
OBJECTIVE
Prior to stereotactic breast biopsy, some radiologists obtain a mammogram image with an overlying alphanumeric grid to mark the skin overlying the target. Our purpose is to determine if this grid image affects stereotactic biopsy efficiency and accuracy, including total images obtained, procedure time and need for retargeting.
MATERIALS AND METHODS
IRB approved, HIPAA compliant retrospective review of prone stereotactic biopsy cases targeting calcifications 9/1/2015 to 9/1/2016 was performed. Images and reports were reviewed for number and type of images obtained, evidence of retargeting and biopsy table time. Attending radiologist, technologist and trainee involvement were recorded. Statistical analysis was performed utilizing SAS statistical software v 9.4 (SAS Institute, Cary, NC).
RESULTS
Of 463 women (avg age 58.0 years, range 30-94), 392/463 (84.7%) had grid images obtained pre-biopsy. Grid patients had more images total than non-grid (avg 9.26 versus 8.44 images/patient; p < 0.0001) but spent less time on the biopsy table (avg 15 min 2 s versus 16 min 44 s/procedure; p < 0.0001). Non-grid patients were more likely to undergo initial retargeting (45% non-grid vs 30% of grid patients; p = 0.013); however, later retargeting after needle placement was comparable (p = 0.3).
CONCLUSION
Grid imaging increases images obtained but decreases retargeting and biopsy table time at the expense of mammogram room/technologist time to obtain the grid image. The overall result is longer total procedure time (grid time plus table time) for the patient/technologist. A grid image therefore has limited usefulness and should be used judiciously in cases where prone positioning is challenging to patients.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Breast; Breast Diseases; Breast Neoplasms; Female; Humans; Image-Guided Biopsy; Imaging, Three-Dimensional; Mammography; Middle Aged; Patient Positioning; Retrospective Studies; Urogenital Surgical Procedures
PubMed: 30321753
DOI: 10.1016/j.clinimag.2018.10.007 -
European Journal of Surgical Oncology :... Dec 2017The 11-gauge (11G) stereotactic vacuum-assisted breast biopsy (VABB) showed a better profile than 14G-VABB in terms of feasibility, safety, microcalcification sampling,... (Comparative Study)
Comparative Study
PURPOSE
The 11-gauge (11G) stereotactic vacuum-assisted breast biopsy (VABB) showed a better profile than 14G-VABB in terms of feasibility, safety, microcalcification sampling, and accuracy. Underestimation rates were significantly lower with 11G-VABB than with 14G-VABB. Thus, the introduction of an even larger needle at the VABB procedure could reduce this rate further. The purpose of this study was to compare the overall performance of stereotactic VABB with 8G and 11G needles.
MATERIALS AND METHODS
Four hundred and three VABBs performed between July 2012 and February 2015 at the Breast Diagnostic Unit of Careggi Hospital in Florence were retrospectively analyzed; 197 were performed with 11G-VABB and 206 with 8G-VABB. Lesions were classified according to mammographical patterns in microcalcifications, architectural distortions, or opacities, and all biopsy targets were classified according to BIRADS classification as BIRADS III, IV or V. Data were collected on radiological classification of targets, imaging presentation, procedure time, number of specimens per procedure, and microcalcification retrieval on histological findings. Surgery was always performed when high-risk or malignant lesions (B3 or B5) were detected; the final diagnosis was made on surgical pathology.
RESULTS
Compared to VABB with an 11G needle, 8G-VABB allows a reduction in the time needed to complete the procedure (20.6 versus 27.4, P < 0.00001) and the number of specimens collected per lesion (21.6 versus 12.2, P < 0.00001). Moreover, 8G-VABB resulted in the same diagnostic accuracy, and the underestimation rates were comparable between the two groups for both B3 and DCIS lesions.
CONCLUSIONS
The 8G needle should be considered as a valid alternative option in VABB for breast lesions.
Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Breast Diseases; Female; Humans; Middle Aged; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Stereotaxic Techniques; Vacuum
PubMed: 29042074
DOI: 10.1016/j.ejso.2017.07.011 -
Academic Radiology Nov 2017With growing adoption of digital breast tomosynthesis, an increasing number of imaging abnormalities are being identified only by tomosynthesis. Upright digital breast... (Review)
Review
With growing adoption of digital breast tomosynthesis, an increasing number of imaging abnormalities are being identified only by tomosynthesis. Upright digital breast tomosynthesis-guided stereotactic biopsy is a proven method for sampling these abnormalities as well as abnormalities traditionally evaluated using conventional stereotactic biopsy. In this article, we describe the technique of upright digital breast tomosynthesis-guided stereotactic biopsy and outline a systematic operational approach to implementation of this technique in clinical radiology practices.
Topics: Breast; Breast Neoplasms; Female; Humans; Image-Guided Biopsy; Mammography
PubMed: 28666725
DOI: 10.1016/j.acra.2017.05.010 -
Seminars in Oncology 2020Brain tumors comprise a heterogeneous group of diseases, featuring different biology, prognosis, and treatment. The most known forms are malignant gliomas and... (Review)
Review
Brain tumors comprise a heterogeneous group of diseases, featuring different biology, prognosis, and treatment. The most known forms are malignant gliomas and metastases. Brain biopsy is a recognized technique in the management of intracranial space-occupying lesions and tumors in particular. Tumor heterogeneity of malignant brain lesions has been described and can lead to significant sampling errors in stereotactic biopsy. Different methods have been used to perform biopsies, including biopsy guided by CT or RMI, echoguided or stereotactic. The choice of the target with the help of PET and MRI with spectroscopy allows one to identify metabolically more active areas of the tumor, and in this way reduce the rate of negative results.
Topics: Adult; Aged; Brain Neoplasms; Female; Humans; Image-Guided Biopsy; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Middle Aged; Multimodal Imaging; Neuronavigation; Positron-Emission Tomography
PubMed: 32513423
DOI: 10.1053/j.seminoncol.2020.04.007 -
World Neurosurgery Dec 2016Stereotactic biopsies are carried out to obtain tumor tissue of unknown entity from cerebral lesions. Thus, tumor tissue can be examined, resulting in correct diagnosis...
BACKGROUND
Stereotactic biopsies are carried out to obtain tumor tissue of unknown entity from cerebral lesions. Thus, tumor tissue can be examined, resulting in correct diagnosis and treatment. These procedures go in hand with high accuracy, high diagnostic yield, and low complication rates.
OBJECTIVES
The aim of this study is to evaluate the results and complications of stereotactic biopsies carried out for lesions of the pineal region.
METHODS
We performed a retrospective analysis of our prospective database and included 14 patients who underwent stereotactic biopsy of a pineal lesion between 2006 and February 2016. The Leksell stereotactic frame was used in all patients, and entry and target points were calculated using the BrainLab stereotactic system. We evaluated histopathologic results and postoperative complications such as hydrocephalus and hemorrhage.
RESULTS
Histopathologic diagnosis was established in all patients. On postoperative computed tomography, 7 patients (50%) showed a circumscribed blood collection at the site of biopsy. Six patients (42.8%) required a cerebrospinal fluid drain preoperatively. Two patients needed external ventricular drain postoperatively (14.2%). One of these patients showed a small hemorrhage area that caused the hydrocephalus. The other patient showed only postoperative swelling. Preoperatively, 2 patients (14.2%) already had a ventriculoperitoneal (VP) shunt, whereas postoperatively, another 4 patients (28.5%) needed a VP shunt. Thus, of the 14 patients, 6 (42.8%) required a VP shunt.
CONCLUSIONS
Because of their localization, pineal lesions may result in emergence of a hydrocephalus. Stereotactic biopsies in this area may increase this effect and, thus, even VP shunts are necessary in some patients.
Topics: Adult; Aged; Biopsy; Brain Neoplasms; Databases, Factual; Drainage; Female; Germinoma; Glioma; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Pineal Gland; Pinealoma; Postoperative Complications; Retrospective Studies; Stereotaxic Techniques; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt; Ventriculostomy
PubMed: 27287513
DOI: 10.1016/j.wneu.2016.04.130 -
World Neurosurgery Feb 2017To evaluate the diagnostic value and safety of stereotactic biopsy in acquired immune deficiency syndrome (AIDS) patients with intracranial lesions via meta-analysis. (Review)
Review
OBJECTIVE
To evaluate the diagnostic value and safety of stereotactic biopsy in acquired immune deficiency syndrome (AIDS) patients with intracranial lesions via meta-analysis.
METHODS
Relevant cohort studies were identified through a literature search in PubMed, Embase, and Ovid from 1985 to October 1, 2016. Appropriate studies were identified per search criteria. Systematic review and meta-analysis were used to assess the diagnostic success rate, changed management rate, clinical improvement rate, mortality rate, morbidity rate, hemorrhage rate, hemorrhage in morbidity rate, and final histologic diagnosis results. Study-specific outcomes were combined per a random effects model. Outcomes were compared between the pre-highly active antiretroviral therapy (HAART) and post-HAART groups. Correlations between outcomes were assessed via meta-regression analysis.
RESULTS
A total of 19 cohort studies with 820 patients were included in this meta-analysis. The weighted proportions per the random effects model were 92.2% (95% confidence interval [CI; 89.3%-94.5%]) for diagnostic success rate, 5.1% (95% CI [2.5%-8.3%]) for morbidity, and 0.7% (95% CI [0%-1.9%]) for mortality. The most common procedure-related morbidity was hemorrhage at 3.3% (95% CI [1.1%-6.3%]). Hemorrhage in morbidity was 78.0% (95% CI [51.4%-97.4%]). Management changed and clinical improvement were 60.4% (95% CI [49.4%-71.0%]) and 34.0% (95% CI [22.2%-46.8%]), respectively. The 4 most common diagnoses were primary central nervous system lymphoma (27.8%; 95% CI [20.2%-36.1%]), progressive multifocal leukoencephalopathy (PML) (21.0%; 95% CI [14.3%-28.4%]), toxoplasma encephalitis (TE) (20.3%; 95% CI [14.3%-27.0%]), and human immunodeficiency virus (HIV) encephalitis (4.1%; 95% CI [1.4%-7.6%]). Multiple diagnoses rate was 1.2% (95% CI [0.0%-3.6%]). HIV encephalitis rate was significantly higher in the post-HAART group than the pre-HAART group (17.9% vs. 3.2%, respectively; P = 0.0024).
CONCLUSIONS
Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patients with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. The 4 most common intracranial lesions in patients with AIDS are lymphoma, PML, TE, and HIV encephalitis.
Topics: AIDS Dementia Complex; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Biopsy; Brain; Female; Humans; Leukoencephalopathy, Progressive Multifocal; Male; Patient Safety; Stereotaxic Techniques; Tomography, X-Ray Computed; Toxoplasmosis, Cerebral
PubMed: 27965075
DOI: 10.1016/j.wneu.2016.11.151 -
Journal of Neuro-oncology Jan 2022Despite advances in modern medicine, brain tumor patients are still monitored purely by clinical evaluation and imaging. Traditionally, invasive strategies such as open... (Review)
Review
INTRODUCTION
Despite advances in modern medicine, brain tumor patients are still monitored purely by clinical evaluation and imaging. Traditionally, invasive strategies such as open or stereotactic biopsies have been used to confirm the etiology of clinical and imaging changes. Liquid biopsies can enable physicians to noninvasively analyze the evolution of a tumor and a patient's response to specific treatments. However, as a consequence of biology and the current limitations in detection methods, no blood or cerebrospinal fluid (CSF) brain tumor-derived biomarkers are used in routine clinical practice. Enhancing the presence of tumor biomarkers in blood and CSF via brain-blood barrier (BBB) disruption with MRI-guided focused ultrasound (MRgFUS) is a very compelling strategy for future management of brain tumor patients.
METHODS
A literature review on MRgFUS-enabled brain tumor liquid biopsy was performed using Medline/Pubmed databases and clinical trial registries.
RESULTS
The therapeutic applications of MRgFUS to target brain tumors have been under intense investigation. At high-intensity, MRgFUS can ablate brain tumors and target tissues, which needs to be balanced with the increased risk for damage to surrounding normal structures. At lower-intensity and pulsed-frequency, MRgFUS may be able to disrupt the BBB transiently. Thus, while facilitating intratumoral or parenchymal access to standard or novel therapeutics, BBB disruption with MRgFUS has opened the possibility of enhanced detection of brain tumor-derived biomarkers.
CONCLUSIONS
In this review, we describe the concept of MRgFUS-enabled brain tumor liquid biopsy and present the available preclinical evidence, ongoing clinical trials, limitations, and future directions of this application.
Topics: Biomarkers; Brain Neoplasms; Forecasting; Humans; Liquid Biopsy; Magnetic Resonance Imaging; Ultrasonic Therapy
PubMed: 34613580
DOI: 10.1007/s11060-021-03837-0