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Acta Neurochirurgica Jun 2024The gold standard for diagnostics in primary central nervous system lymphoma (PCNSL) is histopathological diagnosis after stereotactic biopsy. Yet, PCNSL has a... (Review)
Review
PURPOSE
The gold standard for diagnostics in primary central nervous system lymphoma (PCNSL) is histopathological diagnosis after stereotactic biopsy. Yet, PCNSL has a multidisciplinary diagnostic work up, which associated with diagnostic delay and could result in treatment delay. This article offers recommendations to neurosurgeons involved in clinical decision-making regarding (novel) diagnostics and care for patients with PCNSL with the aim to improve uniformity and timeliness of the diagnostic process for patients with PCNSL.
METHODS
We present a mini review to discuss the role of stereotactic biopsy in the context of novel developments in diagnostics for PCNSL, as well as the role for cytoreductive surgery.
RESULTS
Cerebrospinal fluid-based diagnostics are supplementary and cannot replace stereotactic biopsy-based diagnostics.
CONCLUSION
Histopathological diagnosis after stereotactic biopsy of the brain remains the gold standard for diagnosis. Additional diagnostics should not be a cause of diagnostic delay. There is currently no sufficient evidence supporting cytoreductive surgery in PCNSL, with recent studies showing contradictive data and suboptimal study designs.
Topics: Humans; Central Nervous System Neoplasms; Lymphoma; Time-to-Treatment; Delayed Diagnosis; Neurosurgeons; Biopsy; Stereotaxic Techniques; Cytoreduction Surgical Procedures; Treatment Delay
PubMed: 38858236
DOI: 10.1007/s00701-024-06138-3 -
Frontiers in Oncology 2019Stereotactic brain needle biopsies are indicated for deep-seated or multiple brain lesions and for patients with poor prognosis in whom the risks of resection outweigh... (Review)
Review
Stereotactic brain needle biopsies are indicated for deep-seated or multiple brain lesions and for patients with poor prognosis in whom the risks of resection outweigh the potential outcome benefits. The main goal of such procedures is not to improve the resection extent but to safely acquire viable tissue representative of the lesion for further comprehensive histological, immunohistochemical, and molecular analyses. Herein, we review advanced optical techniques for improvement of safety and efficacy of stereotactic needle biopsy procedures. These technologies are aimed at three main areas of improvement: (1) avoidance of vessel injury, (2) guidance for biopsy acquisition of the viable diagnostic tissue, and (3) methods for rapid intraoperative assessment of stereotactic biopsy specimens. The recent technological developments in stereotactic biopsy probe design include the incorporation of fluorescence imaging, spectroscopy, and label-free imaging techniques. The future advancements of stereotactic biopsy procedures in neuro-oncology include the incorporation of optical probes for real-time vessel detection along and around the biopsy needle trajectory and confirmation of the diagnostic tumor tissue prior to sample acquisition.
PubMed: 31632903
DOI: 10.3389/fonc.2019.00947 -
Open Access Macedonian Journal of... Mar 2015Neurosurgeons have preferred to perform the stereotactic biopsy for pathologic diagnosis when the intracranial pathology located eloquent areas and deep sites of the...
BACKGROUND
Neurosurgeons have preferred to perform the stereotactic biopsy for pathologic diagnosis when the intracranial pathology located eloquent areas and deep sites of the brain.
AIM
To get a higher ratio of definite pathologic diagnosis during stereotactic biopsy and develop practical method.
MATERIAL AND METHODS
We determined at least two different target points and two different trajectories to take brain biopsy during stereotactic biopsy. It is a different way from the conventional stereotactic biopsy method in which one point has been selected to take a biopsy. We separated our patients into two groups, group 1 (N=10), and group 2 (N= 19). We chose one target to take a biopsy in group 1, and two different targets and two different trajectories in group 2. In group 2, one patient underwent craniotomy due to hemorrhage at the site of the biopsy during tissue biting. However, none of the patients in both groups suffered any neurological complication related biopsy procedure.
RESULTS
In group 1, two of 10 cases, and, in group 2, fourteen of 19 cases had positive biopsy harvesting. These results showed statistically significant difference between group 1 and group 2 (P<0.05).
CONCLUSIONS
Regarding these results, choosing more than one trajectories and taking at least six specimens from each target provides higher diagnostic rate in stereotaxic biopsy taking method.
PubMed: 27275204
DOI: 10.3889/oamjms.2015.016 -
Orthopaedic Surgery Aug 2022This study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically...
Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme, Biopsy Procedure, Core Technique Analysis, Diagnostic Yield and Clinical Outcome.
OBJECTIVE
This study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy.
METHODS
A series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including "lesion perforating", "aspiration", "cutting-and-scraping" and "biopsy forceps utilization" were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case.
RESULTS
Eight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow-up period (1-39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores.
CONCLUSION
With a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well-tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.
Topics: Aged; Axis, Cervical Vertebra; Biopsy; Cervical Atlas; Endoscopy; Female; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 35706342
DOI: 10.1111/os.13366 -
Chest Mar 2017The detection of peripheral lung nodules is increasing because of the expanded use of CT imaging and implementation of lung cancer screening recommendations. Although... (Review)
Review
The detection of peripheral lung nodules is increasing because of the expanded use of CT imaging and implementation of lung cancer screening recommendations. Although surgical resection of malignant nodules remains the treatment modality of choice at present, many patients are not surgical candidates, thus prompting the need for other therapeutic options. Stereotactic body radiotherapy (SBRT) and percutaneous thermal ablation are emerging as viable alternatives to surgical resection. For safety, efficacy, and cost-effectiveness purposes, however, alternative bronchoscopic methods for treatment of peripheral lung cancer are currently under active exploration. We searched the Cochrane Library and MEDLINE from 1990 to 2015 to provide the most comprehensive review of bronchoscopic treatment of malignant lung nodules. We used the following search terms: bronchoscopy, lung nodule, peripheral lung lesion, and bronchoscopic treatment. We focused on peripheral pulmonary nodules that are confirmed or highly likely to be malignant. Seventy-one articles were included in this narrative review. We have provided an overview of advanced bronchoscopic modalities that have been used or are under active investigation for definitive treatment of malignant pulmonary nodules. We have concisely discussed the use of direct intratumoral chemotherapy or gene therapies, transbronchial brachytherapy, bronchoscopy-guided radiofrequency ablation (RFA), placement of markers to guide real time-radiation and surgery, cryotherapy, and photodynamic therapy. We have also briefly reported on emerging technologies such as vapor ablation of lung parenchyma for lung cancers. Advances in bronchoscopic therapy will bring additional treatment options to patients with peripheral lung malignancies, with putative advantages over other minimally invasive modalities.
Topics: Antineoplastic Agents; Brachytherapy; Bronchoscopy; Catheter Ablation; Cryosurgery; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Injections, Intralesional; Lung Neoplasms; Photochemotherapy; Radiosurgery
PubMed: 27292045
DOI: 10.1016/j.chest.2016.05.025 -
Neurology India Dec 2003Thirty patients with low-grade (WHO Grade II) astrocytomas involving the insula, who had undergone stereotactic biopsy followed by radiotherapy, were followed up to...
Thirty patients with low-grade (WHO Grade II) astrocytomas involving the insula, who had undergone stereotactic biopsy followed by radiotherapy, were followed up to evaluate the outcome with regard to control of seizures, memory and language function, Karnofsky Performance scale and regression in tumor volume. Patients were followed up for a mean of 27.8 months, during which time they showed improvement in all the factors that were studied. A statistically significant change was, however, seen only in the reduction in tumor size, probably due to the small sample size and the short duration of follow-up. Stereotactic biopsy followed by radiation therapy provides a good short-term outcome in patients with low-grade insular astrocytomas.
Topics: Adult; Astrocytoma; Biopsy; Brain Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 14742933
DOI: No ID Found -
Taehan Yongsang Uihakhoe Chi May 2022To determine the incidence of atypical ductal hyperplasia (ADH) in needle biopsy and the upgrade rate to carcinoma, and to evaluate difference in findings between the...
PURPOSE
To determine the incidence of atypical ductal hyperplasia (ADH) in needle biopsy and the upgrade rate to carcinoma, and to evaluate difference in findings between the upgrade and non-upgrade groups.
MATERIALS AND METHODS
Among 9660 needle biopsies performed over 48 months, we reviewed the radiologic and histopathologic findings of ADH and compared the differences in imaging findings (mammography and breast US) and biopsy methods between the upgrade and non-upgrade groups.
RESULTS
The incidence of ADH was 1.7% (169/9660). Of 112 resected cases and 30 cases followed-up for over 2 years, 35 were upgraded to carcinoma (24.6%, 35/142). The upgrade rates were significantly different according to biopsy methods: US-guided core needle biopsy (US-CNB) (40.7%, 22/54) vs. stereotactic-vacuum-assisted biopsy (S-VAB) (16.0%, 12/75) vs. US-guided VAB (US-VAB) (7.7%, 1/13) ( = 0.002). Multivariable analysis showed that only US-CNB (odds ratio = 5.19, 95% confidence interval: 2.16-13.95, < 0.001) was an independent predictor for pathologic upgrade. There was no upgrade when a sonographic mass was biopsied by US-VAB ( = 7).
CONCLUSION
The incidence of ADH was relatively low (1.7%) and the upgrade rate was 24.6%. Surgical excision should be considered because of the considerable upgrade rate, except in the case of US-VAB.
PubMed: 36238508
DOI: 10.3348/jksr.2021.0109 -
International Journal of Oncology Mar 2021Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non‑Hodgkin lymphoma that is unique and different from systemic diffuse large B‑cell... (Review)
Review
Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non‑Hodgkin lymphoma that is unique and different from systemic diffuse large B‑cell lymphomas. The median age at diagnosis of PCNSL is 65 years and its incidence is rising rapidly in the elderly population. A total of ≥20% of all patients with PCNSL are ≥80 years old. Notably, age has been identified as an independent poor prognostic factor for PCNSL. Elderly patients have an inferior prognosis to that of younger patients and are more severely affected by iatrogenic toxicity; therefore, elderly patients represent a unique and vulnerable treatment subgroup. The present review summarized the available literature to provide an improved understanding of the epidemiology, clinical characteristics, diagnosis, prognosis and management of PCNSL in the elderly population. Notably, the incidence of PCNSL in immunocompetent elderly patients, predominantly in men, is increasing. For the diagnosis of CNSL, imaging‑guided stereotactic biopsy is considered the gold standard. When stereotactic biopsy is not possible or conclusive, certain biomarkers have been described that can help establish a diagnosis. PCNSL has a very poor prognosis in the elderly, even though several prognostic scoring systems exist and several prognostic markers have been reported in patients with PCNSL. Furthermore, the treatment of elderly patients remains challenging; it is unlikely that a novel agent could be used as a curative monotherapy; however, a combination of novel agents with polychemotherapy or its combination with other novel drugs may have therapeutic potential.
Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Biopsy; Central Nervous System Neoplasms; Humans; Lymphoma, Non-Hodgkin; Prognosis; Progression-Free Survival; Stereotaxic Techniques
PubMed: 33650642
DOI: 10.3892/ijo.2021.5180 -
Turkish Neurosurgery 2011Histopathological diagnosis is always necessary to make an effective treatment plan for intracranial mass lesions. This study aimed to evaluate the diagnostic efficacy,...
AIM
Histopathological diagnosis is always necessary to make an effective treatment plan for intracranial mass lesions. This study aimed to evaluate the diagnostic efficacy, and associated mortality and morbidity of CT-guided stereotactic biopsy procedures in a large number of patients with intracranial lesions.
MATERIAL AND METHODS
A total of 290 cases undergoing CT-guided stereotactic biopsy for intracranial lesions were included in this retrospective study. Clinical, radiological and histological data in patient records were examined.
RESULTS
The mean age of the patients was 46.6 years (range: 2-82 y). Pediatric patients comprised 6.3% (n=13) of the total population. Examination of paraffin embedded histological preparations revealed a tumoral mass in 240 (82.8%), a non-tumoral mass in 37 (12.8%), and non-definable lesions in 13 (4.5%). Therefore, the diagnostic value in this series was 95.5%. Postoperative mortality rate was 0.8% (n=2). When histopathological diagnoses made after biopsy and surgical resection were compared in 42 patients with available data, a complete or partial agreement was present in 90.5%.
CONCLUSION
Our findings support that frame based-stereotactic biopsy is a safe and valuable technique that allows the neurosurgeon to obtain tissue samples for histopathological diagnosis of intracranial mass lesions in almost any region.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Brain Diseases; Brain Neoplasms; Child; Child, Preschool; Female; Humans; Intraoperative Complications; Male; Middle Aged; Monitoring, Intraoperative; Neuronavigation; Patient Safety; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Stereotaxic Techniques; Tomography, X-Ray Computed; Young Adult
PubMed: 22194120
DOI: No ID Found -
European Journal of Medical Research Jun 2021To determine the role of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) imaging to guide stereotactic biopsy for the...
OBJECTIVE
To determine the role of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) imaging to guide stereotactic biopsy for the diagnosis of intracranial angiitis.
CASE PRESENTATION
In a 28-year-old woman who had experienced inactive headache and right limbs numbness for 4 days, preoperative magnetic resonance (MR) scanning, enhanced scanning, diffusion tensor imaging, magnetic resonance spectroscopy, diffusion-weighted imaging (DWI), and ADC image scanning were performed. Stereotactic biopsy was performed in one target where the area of edema detected with MR FLAIR, and two targets where the area shown as a high-value and a lower value area in the DWI/ADC image. Pathological examinations together with computed tomographic and enhanced MRI scans were conducted after surgery. A preoperative enhanced MRI scan showed a uniform low-intensity lesion in the patient's left centrum semiovale, with a volume of 3.1 cm. The DWI and ADC images showed uneven high-intensity signals and different ADC values in the lesion area, respectively. During surgery, tissues around the lesion and the lesion center were sampled at the three selected targets. The postoperative pathological diagnosis was primary angiitis of the central nervous system, and the patient was given anti-inflammatory medication and hormone therapy. The 3-year follow-up confirmed that the patient had recovered well, with a Glasgow Outcome Scale score of five.
CONCLUSION
DW-MRI and ADC images can be reliably used to determine the location of small intracranial lesions, and guide stereotactic biopsy to facilitate the diagnosis of primary vasculitis of the central nervous system.
Topics: Adult; Biopsy; Brain; Diffusion Magnetic Resonance Imaging; Diffusion Tensor Imaging; Female; Humans; Imaging, Three-Dimensional; Tomography, X-Ray Computed; Vasculitis, Central Nervous System
PubMed: 34162432
DOI: 10.1186/s40001-021-00529-3