Stereotactic biopsy in the diagnosis of brain tumors and non-neoplastic lesions: prescription, accuracy and diagnostic difficulties

José Eymard Homem Pittella About the author

OBJECTIVE: Stereotactic biopsy (SB) is an invaluable and safe procedure in the diagnosis of intracranial expanding lesions. This review analyses the literature as to the relevance and accuracy of SB in the diagnosis of brain tumors and non-neoplastic lesions. RESULTS: The main anatomicopathologic findings of approximately 11,500 stereotactic brain biopsies from large series published between 1980 and 2008 were reviewed. A histopathological diagnosis was reached in 80% to 99% of the patients. The most frequently found lesions were neoplasms (64% to 86.4%), especially gliomas (61.7% to 71%), and non-neoplastic lesions (4% to 32%). The diagnosis was non-conclusive in 3.4% to 18.7% of the samples. The most common non-neoplastic lesions were infections (8% to 15%) and infarcts (0.6% to 6%). Non-diagnostic specimens were obtained due to small sample size, small lesions, lesions located in deep brain structures and inaccurate tissue targeting resulting in sampling error. The use of intraoperative smear and/or frozen section allowed a rapid diagnosis with high level of accuracy as well as it improved the quality of specimens collected during SB procedure. CONCLUSIONS: SB is a safe and effective procedure for evaluating intracranial expanding lesions when craniotomy and an open surgical resection are not recommended. It has high accuracy as long as it is performed by experienced and skilled professionals and examined by experienced pathologists or neuropathologists. The use of smear and/or frozen section increases the diagnostic yield of SB.

Stereotactic biopsy; Brain; Neoplasm; Infection; Pathology; Diagnosis

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