Carolina Noronha1,2, Gonçalo Figueiredo3, Célia Pinheiro3, Ernesto Carvalho3, Alfredo Calheiros3, Manuel Melo Pires4, Ricardo Taipa4. 1. Neurosurgery Department, Hospital Santo Antonio, Centro Hospitalar e Universitario do Porto, Largo Prof Abel Salazar, Porto, 4099-001, Portugal. noronhac44@gmail.com. 2. i3s Institute for Research and Innovation in Health, Universidade do Porto, Porto, Portugal. noronhac44@gmail.com. 3. Neurosurgery Department, Hospital Santo Antonio, Centro Hospitalar e Universitario do Porto, Largo Prof Abel Salazar, Porto, 4099-001, Portugal. 4. Neuropathology Unit, Hospital de Santo Antonio, Centro Hospitalar e Universitario do Porto, Porto, Portugal.
Abstract
Brain biopsy has a well-established role in the diagnosis of CNS neoplasia. Nevertheless, despite being essential for the diagnosis of some benign neurological diseases, little consensus exists regarding its indications for disease diagnosis and patient orientation. Our aim was to assess brain biopsy diagnostic yield in patients with neurological deterioration of unknown etiology, to identify the clinical characteristics associated with an increased likelihood of achieving a diagnostic biopsy as well as the characteristics linked to a particular diagnosis. METHODS: A retrospective analysis of 62 consecutive brain biopsies performed at a single tertiary care center between January 2004 and December 2015 for suspected non-neoplastic neurological disease was performed. The clinical presentation, imaging, and laboratory results were collected and compared between diagnostic groups. RESULTS: Sixty-eight percent of the biopsies led to a definitive diagnosis. The most common histological diagnosis was central nervous system lymphoma (eight cases), followed by astrocytoma, demyelinating disease, and progressive multifocal leukoencephalopathy (four cases each). No clinical characteristics were found to predict a diagnostic biopsy or to correlate with a specific diagnosis. Importantly, a distinct diagnosis from the initially suspected was achieved in 52% of cases and biopsy findings led to a change of therapeutic orientation in 78% of the cases. CONCLUSIONS: Our results suggest that brain biopsies have a significant impact on patient management and should be considered early in selected cases in which less invasive testing was unable to reach a definitive diagnosis.
Brain biopsy has a well-established role in the diagnosis of CNS neoplasia. Nevertheless, despite being essential for the diagnosis of some benign neurological diseases, little consensus exists regarding its indications for disease diagnosis and patient orientation. Our aim was to assess brain biopsy diagnostic yield in patients with neurological deterioration of unknown etiology, to identify the clinical characteristics associated with an increased likelihood of achieving a diagnostic biopsy as well as the characteristics linked to a particular diagnosis. METHODS: A retrospective analysis of 62 consecutive brain biopsies performed at a single tertiary care center between January 2004 and December 2015 for suspected non-neoplastic neurological disease was performed. The clinical presentation, imaging, and laboratory results were collected and compared between diagnostic groups. RESULTS: Sixty-eight percent of the biopsies led to a definitive diagnosis. The most common histological diagnosis was central nervous system lymphoma (eight cases), followed by astrocytoma, demyelinating disease, and progressive multifocal leukoencephalopathy (four cases each). No clinical characteristics were found to predict a diagnostic biopsy or to correlate with a specific diagnosis. Importantly, a distinct diagnosis from the initially suspected was achieved in 52% of cases and biopsy findings led to a change of therapeutic orientation in 78% of the cases. CONCLUSIONS: Our results suggest that brain biopsies have a significant impact on patient management and should be considered early in selected cases in which less invasive testing was unable to reach a definitive diagnosis.
Authors: Gelsomina Mansueto; Giuseppe Lanza; Francesco Fisicaro; Danielle Alaouieh; Emily Hong; Sara Girolami; Marco Montella; Alessandro Feola; Mario Di Napoli Journal: Curr Neurol Neurosci Rep Date: 2022-02-09 Impact factor: 6.030