Serial stereotactic biopsy of brainstem lesions in adults improves diagnostic accuracy compared with MRI only.
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vor 15 Jahren
Objective: The aim of the current prospective study was to analyse
the validity of MRI based diagnosis of brainstem gliomas which was
verified by stereotactic biopsy and follow-up evaluation as well as
to assess prognostic factors and risk profile. Methods: Between
1998 and 2007, all consecutive adult patients with radiologically
suspected brainstem glioma were included. The MRI based diagnosis
of the lesions was made independently by an experienced
neuroradiologist. Histopathological evaluation was performed in all
patients from paraffin embedded specimens obtained by multimodal
image guided stereotactic serial biopsy technique.
Histopathological results were compared with prior radiological
assessment. Length of survival was estimated with the Kaplan–Meier
method and prognostic factors were calculated using the Cox model.
Results: 46 adult patients were included. Histological evaluation
revealed pilocytic astrocytoma (n=2), WHO grade II glioma (n=14),
malignant glioma (n=12), metastasis (n=7), lymphoma (n=5),
cavernoma (n=1), inflammatory disease (n=2) or no tumour/ gliosis
(n=3). Perioperative morbidity was 2.5% (n=1). There was no
permanent morbidity and no mortality. All patients with ‘‘no
tumour’’ or ‘‘inflammatory disease’’ survived. Patients with low
grade glioma and malignant glioma showed a 1 year survival rate of
75% and 25%, respectively; the 1 year survival rate for patients
with lymphoma or metastasis was 30%. In the subgroup with a
verified brainstem glioma, negative predictors for length of
survival were higher tumour grade (p=0.002) and Karnofsky
performance score (70 (p=0.004). Conclusion: Intra-axial brainstem
lesions with a radiological pattern of glioma represent a very
heterogeneous tumour group with completely different outcomes.
Radiological features alone are not reliable for diagnostic
classification. Stereotactic biopsy is a safe method to obtain a
valid tissue diagnosis, which is indispensible for treatment
decision.
the validity of MRI based diagnosis of brainstem gliomas which was
verified by stereotactic biopsy and follow-up evaluation as well as
to assess prognostic factors and risk profile. Methods: Between
1998 and 2007, all consecutive adult patients with radiologically
suspected brainstem glioma were included. The MRI based diagnosis
of the lesions was made independently by an experienced
neuroradiologist. Histopathological evaluation was performed in all
patients from paraffin embedded specimens obtained by multimodal
image guided stereotactic serial biopsy technique.
Histopathological results were compared with prior radiological
assessment. Length of survival was estimated with the Kaplan–Meier
method and prognostic factors were calculated using the Cox model.
Results: 46 adult patients were included. Histological evaluation
revealed pilocytic astrocytoma (n=2), WHO grade II glioma (n=14),
malignant glioma (n=12), metastasis (n=7), lymphoma (n=5),
cavernoma (n=1), inflammatory disease (n=2) or no tumour/ gliosis
(n=3). Perioperative morbidity was 2.5% (n=1). There was no
permanent morbidity and no mortality. All patients with ‘‘no
tumour’’ or ‘‘inflammatory disease’’ survived. Patients with low
grade glioma and malignant glioma showed a 1 year survival rate of
75% and 25%, respectively; the 1 year survival rate for patients
with lymphoma or metastasis was 30%. In the subgroup with a
verified brainstem glioma, negative predictors for length of
survival were higher tumour grade (p=0.002) and Karnofsky
performance score (70 (p=0.004). Conclusion: Intra-axial brainstem
lesions with a radiological pattern of glioma represent a very
heterogeneous tumour group with completely different outcomes.
Radiological features alone are not reliable for diagnostic
classification. Stereotactic biopsy is a safe method to obtain a
valid tissue diagnosis, which is indispensible for treatment
decision.
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