Tommaso Sciortino1,2, Bethania Fernandes3, Marco Conti Nibali1,2, Lorenzo G Gay1,2, Marco Rossi1,2, Egesta Lopci4, Anna E Colombo3, Maria G Elefante3, Federico Pessina2,5, Lorenzo Bello2,6, Marco Riva7,8. 1. Università degli Studi di Milano, Milan, Italy. 2. Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy. 3. Unit of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy. 4. Unit of Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy. 5. Department of Biomedical Sciences, Humanitas University, Rozzano (MI), Italy. 6. Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy. 7. Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy. marco.riva@unimi.it. 8. Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy. marco.riva@unimi.it.
Abstract
BACKGROUND: Stereotactic biopsy is consistently employed to characterize cerebral lesions in patients who are not suitable for microsurgical resection. In the past years, technical improvement and neuroimaging advancements contributed to increase the diagnostic yield, the safety, and the application of this procedure. Currently, in addition to histological diagnosis, the molecular analysis is considered essential in the diagnostic process to properly select therapeutic and prognostic algorithms in a personalized approach. The present study reports our experience with frameless stereotactic brain biopsy in this molecular era. METHODS: One hundred forty consecutive patients treated from January 2013 to September 2018 were analyzed. Biopsies were performed using the Brainlab Varioguide® frameless stereotactic system. Patients' clinical and demographic data, the time of occupation of the operating room, the surgical time, the morbidity, and the diagnostic yield in providing a histological and molecular diagnosis were recorded and evaluated. RESULTS: The overall diagnostic yield was 93.6% with nine procedures resulting non-diagnostic. Among 110 patients with glioma, the IDH-1 mutational status was characterized in 108 cases (98.2%), resulting wild-type in all subjects but 3; MGMT methylation was characterized in 96 cases (87.3%), resulting present in 60 patients, and 1p/19q codeletion was founded in 6 of the 20 cases of grade II-III gliomas analyzed. All the specimens were apt for molecular analysis when performed. Bleeding requiring surgical drainage occurred in 2.1% of the cases; 8 (5.7%) asymptomatic hemorrhages requiring no treatment were observed. No biopsy-related mortality was recorded. Median length of hospital stay was 5 days (IQR 4-8) with mean surgical time of 60.77 min (± 23.12) and 137.44 ± 24.1 min of total occupation time of the operative room. CONCLUSIONS: Stereotactic frameless biopsy is a safe, feasible, and fast procedure to obtain a histological and molecular diagnosis.
BACKGROUND: Stereotactic biopsy is consistently employed to characterize cerebral lesions in patients who are not suitable for microsurgical resection. In the past years, technical improvement and neuroimaging advancements contributed to increase the diagnostic yield, the safety, and the application of this procedure. Currently, in addition to histological diagnosis, the molecular analysis is considered essential in the diagnostic process to properly select therapeutic and prognostic algorithms in a personalized approach. The present study reports our experience with frameless stereotactic brain biopsy in this molecular era. METHODS: One hundred forty consecutive patients treated from January 2013 to September 2018 were analyzed. Biopsies were performed using the Brainlab Varioguide® frameless stereotactic system. Patients' clinical and demographic data, the time of occupation of the operating room, the surgical time, the morbidity, and the diagnostic yield in providing a histological and molecular diagnosis were recorded and evaluated. RESULTS: The overall diagnostic yield was 93.6% with nine procedures resulting non-diagnostic. Among 110 patients with glioma, the IDH-1 mutational status was characterized in 108 cases (98.2%), resulting wild-type in all subjects but 3; MGMT methylation was characterized in 96 cases (87.3%), resulting present in 60 patients, and 1p/19q codeletion was founded in 6 of the 20 cases of grade II-III gliomas analyzed. All the specimens were apt for molecular analysis when performed. Bleeding requiring surgical drainage occurred in 2.1% of the cases; 8 (5.7%) asymptomatic hemorrhages requiring no treatment were observed. No biopsy-related mortality was recorded. Median length of hospital stay was 5 days (IQR 4-8) with mean surgical time of 60.77 min (± 23.12) and 137.44 ± 24.1 min of total occupation time of the operative room. CONCLUSIONS: Stereotactic frameless biopsy is a safe, feasible, and fast procedure to obtain a histological and molecular diagnosis.
Authors: John Lynes; Alvina A Acquaye; Hannah Sur; Anthony Nwankwo; Victoria Sanchez; Elizabeth Vera; Tianxia Wu; Brett Theeler; Terri S Armstrong; Mark R Gilbert; Edjah K Nduom Journal: J Neurooncol Date: 2020-07-23 Impact factor: 4.130