OBJECTIVE:Use of the image-guided stereotactic brain biopsy has facilitated the diagnosis of previously inaccessible lesions with both safety and reliability. However, few studies have assessed the diagnostic yield of frozen section evaluation of the initial stereotactic target (FS-0). We describe our experience with 188 stereotactic brain biopsies in order to evaluate the diagnostic yield of FS-0.

DESIGN:Retrospective study of 188 stereotactic brain biopsies from 185 patients.

SETTING:Tertiary referral center with a high volume of neurosurgical cases including image-guided stereotactic brain biopsies.

PATIENTS:One hundred eighty-five patients who underwent imaged-guided stereotactic brain biopsy over a 58-month period.

RESULTS:The patients studied included 107 males and 78 females (mean age 48 years). Eleven (6%) biopsies were nondiagnostic. Diagnoses from FS-0 included a neoplastic condition in 96 (73%) of 131 cases and a nonneoplastic condition in 23 (50%) of 46 cases. In 119 (67%) of 177 cases, a diagnosis was reached at FS-0. A correct diagnosis was made on subsequent frozen section in 28 (16%) of cases, including 21 (16%) of 131 neoplasms and 7 (15%) of nonneoplastic conditions. In 15 (54%) of 28 cases, the correct diagnosis was made on the second frozen section; in 25 (89%) of 28, the correct diagnosis was made by the fourth frozen section. In 14 (11%) of 131 neoplastic cases, a sampling error relative to the lesion resulted in an inaccurate diagnosis at FS-0. A significant error in diagnosis occurred in three cases (1.7%).

CONCLUSIONS:We conclude that (1) because 58 (33%) of 177 diagnosed cases in our series would have been potentially misdiagnosed if only one biopsy had been taken at the stereotactic target, frozen section evaluation or cytologic examination of material at the time of surgery should be performed routinely to ensure that adequate tissue has been obtained for purposes of diagnosis; (2) taking up to four biopsies increases the diagnostic yield (from 67% to 89% in this series); and (3) neoplastic lesions are more likely to be definitively diagnosed at FS-0 than non-neoplastic lesions.

译文

目标:使用图像引导的立体定向脑活检技术,既安全又可靠,有助于诊断先前难以接近的病变。但是,很少有研究评估初始立体定位目标(FS-0)的冷冻切片评估的诊断率。为了描述FS-0的诊断结果,我们描述了188例立体定向脑活检的经验。

DESIGN :对185例患者的188例立体定向脑活检进行了回顾性研究。
设置:拥有大量神经外科病例的三级转诊中心,包括图像引导的立体定向脑活检。

患者:一百八十五

结果:接受影像引导的立体定向脑活检的患者。研究的患者包括107例男性和78例女性(平均年龄48岁)。 11例(6%)活检未确诊。 FS-0的诊断包括131例中的96例(73%)为肿瘤性疾病和46例中23例(50%)为非肿瘤性疾病。在177例病例中,有119例(67%)达到了FS-0的诊断。在随后的冰冻切片中,有28例(16%)做出了正确的诊断,包括131例肿瘤中的21例(16%)和7例(15%)的非肿瘤性疾病。在28例病例中,有15例(54%)对第二个冷冻切片做出了正确的诊断。 28例中有25例(89%)通过第四次冰冻切片做出了正确的诊断。在131例肿瘤病例中,有14例(11%)相对于病变的采样错误导致FS-0诊断不准确。结论3例诊断错误(1.7%)。

结论:我们得出结论:(1)因为本系列177例诊断病例中有58例(33%)如果仅在立体定向目标上进行了一次活检,可能会被误诊,在手术时应常规进行冰冻切片评估或材料的细胞学检查,以确保获得足够的组织用于诊断; (2)最多进行四次活检可以提高诊断率(在本系列中从67%增至89%); (3)FS-0比非肿瘤性病变更有可能明确诊断出肿瘤性病变。

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