Safety and diagnostic accuracy of neuroendoscopic biopsies

An international multicenter study

Shlomi Constantini, Aaron Mohanty, Samuel Zymberg, Sergio Cavalheiro, Conor Mallucci, Dieter Hellwig, Yusuf Ersahin, Hiroshi Mori, Carmelo Mascari, José Aloysio Costa Val, Wolfgang Wagner, Abhaya V. Kulkarni, Spyros Sgouros, Shizuo Oi

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Object. Analysis of the safety and morbidity of neuroendoscopic biopsies (NEBs), as well as the reliability in obtaining an accurate diagnosis, has until now been based on studies with relatively small sample sizes. Through the cooperative efforts of several international medical centers, authors of the present study collected data on a large number of patients to obtain better insight into this issue. When possible, they compared pathology obtained through an NEB with the "gold-standard" pathology obtained in open surgery. Methods. Thirteen randomly chosen medical centers in 9 countries collected data for patients who had undergone NEB, which were then analyzed for universal complications, bleeding, navigation technique, pathology, mismatch between biopsy results and final diagnosis, and a number of other potentially influential factors. Results. Data for 293 patients were analyzed. Sixty percent of the patients were male, and patient ages ranged from 0.1 to 78.7 years (median age 20.4 years). The most common tumor locations were pineal (33.1%), thalamic (16.7%), tectal (13%), and hypothalamic (4.4%). Fifty percent of the tumors were larger than 20 mm, 36% were between 10 and 20 mm, and 14% were smaller than 10 mm. Intraoperative bleeding was seen in 275 patients (94%). The amount of blood was noted as mild in 75%, moderate in 13%, and severe in 6%. Infection occurred in 8 patients (3%). Death occurred in 1 patient (0.3%), which was caused by severe intraoperative bleeding. Biopsies were informative in 265 patients (90.4%). Seventy-eight patients (26.6%) had open surgery following the NEB. For these patients, the pathology results from the NEB were compared with those from the open surgery that followed. In 14 cases (17.9%) there was disagreement on the pathology. Of these cases, a meaningful mismatch, in which the erroneous NEB pathology could have led to an inappropriate management decision, occurred in 9 cases (11.5%). Most of these meaningful mismatches were lesions diagnosed as low-grade or pilocytic astrocytoma on the NEB and later proved to be high-grade astrocytoma (4 cases) and 1 case each of meningioma, cavernoma, primitive neuroectodermal tumor, neurocysticercosis, and pineocytoma. Conclusions. In experienced hands, NEBs can be performed with low morbidity and mortality, providing meaningful pathological data for the majority of patients with a wide range of tumor types, locations, and presentations. These biopsies also offer other advantages, such as the ability to perform concomitant endoscopic third ventriculostomy and septum pellucidotomy. However, due caution must be maintained, since pathology obtained from an NEB, as with stereotactic biopsies, may be subject to sampling errors, especially when the results seem to indicate a low-grade glial tumor.

Original languageEnglish (US)
Pages (from-to)704-709
Number of pages6
JournalJournal of Neurosurgery: Pediatrics
Volume11
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Multicenter Studies
Biopsy
Safety
Pathology
Astrocytoma
Hemorrhage
Neoplasms
Pinealoma
Ventriculostomy
Neurocysticercosis
Morbidity
Primitive Neuroectodermal Tumors
Selection Bias
Meningioma
Neuroglia
Gold
Sample Size

Keywords

  • Brain tumor
  • Endoscopy
  • Neuroendoscopic biopsy
  • Neuropathology
  • Stereotactic biopsy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Safety and diagnostic accuracy of neuroendoscopic biopsies : An international multicenter study. / Constantini, Shlomi; Mohanty, Aaron; Zymberg, Samuel; Cavalheiro, Sergio; Mallucci, Conor; Hellwig, Dieter; Ersahin, Yusuf; Mori, Hiroshi; Mascari, Carmelo; Costa Val, José Aloysio; Wagner, Wolfgang; Kulkarni, Abhaya V.; Sgouros, Spyros; Oi, Shizuo.

In: Journal of Neurosurgery: Pediatrics, Vol. 11, No. 6, 06.2013, p. 704-709.

Research output: Contribution to journalArticle

Constantini, S, Mohanty, A, Zymberg, S, Cavalheiro, S, Mallucci, C, Hellwig, D, Ersahin, Y, Mori, H, Mascari, C, Costa Val, JA, Wagner, W, Kulkarni, AV, Sgouros, S & Oi, S 2013, 'Safety and diagnostic accuracy of neuroendoscopic biopsies: An international multicenter study', Journal of Neurosurgery: Pediatrics, vol. 11, no. 6, pp. 704-709. https://doi.org/10.3171/2013.3.PEDS12416
Constantini, Shlomi ; Mohanty, Aaron ; Zymberg, Samuel ; Cavalheiro, Sergio ; Mallucci, Conor ; Hellwig, Dieter ; Ersahin, Yusuf ; Mori, Hiroshi ; Mascari, Carmelo ; Costa Val, José Aloysio ; Wagner, Wolfgang ; Kulkarni, Abhaya V. ; Sgouros, Spyros ; Oi, Shizuo. / Safety and diagnostic accuracy of neuroendoscopic biopsies : An international multicenter study. In: Journal of Neurosurgery: Pediatrics. 2013 ; Vol. 11, No. 6. pp. 704-709.
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T1 - Safety and diagnostic accuracy of neuroendoscopic biopsies

T2 - An international multicenter study

AU - Constantini, Shlomi

AU - Mohanty, Aaron

AU - Zymberg, Samuel

AU - Cavalheiro, Sergio

AU - Mallucci, Conor

AU - Hellwig, Dieter

AU - Ersahin, Yusuf

AU - Mori, Hiroshi

AU - Mascari, Carmelo

AU - Costa Val, José Aloysio

AU - Wagner, Wolfgang

AU - Kulkarni, Abhaya V.

AU - Sgouros, Spyros

AU - Oi, Shizuo

PY - 2013/6

Y1 - 2013/6

N2 - Object. Analysis of the safety and morbidity of neuroendoscopic biopsies (NEBs), as well as the reliability in obtaining an accurate diagnosis, has until now been based on studies with relatively small sample sizes. Through the cooperative efforts of several international medical centers, authors of the present study collected data on a large number of patients to obtain better insight into this issue. When possible, they compared pathology obtained through an NEB with the "gold-standard" pathology obtained in open surgery. Methods. Thirteen randomly chosen medical centers in 9 countries collected data for patients who had undergone NEB, which were then analyzed for universal complications, bleeding, navigation technique, pathology, mismatch between biopsy results and final diagnosis, and a number of other potentially influential factors. Results. Data for 293 patients were analyzed. Sixty percent of the patients were male, and patient ages ranged from 0.1 to 78.7 years (median age 20.4 years). The most common tumor locations were pineal (33.1%), thalamic (16.7%), tectal (13%), and hypothalamic (4.4%). Fifty percent of the tumors were larger than 20 mm, 36% were between 10 and 20 mm, and 14% were smaller than 10 mm. Intraoperative bleeding was seen in 275 patients (94%). The amount of blood was noted as mild in 75%, moderate in 13%, and severe in 6%. Infection occurred in 8 patients (3%). Death occurred in 1 patient (0.3%), which was caused by severe intraoperative bleeding. Biopsies were informative in 265 patients (90.4%). Seventy-eight patients (26.6%) had open surgery following the NEB. For these patients, the pathology results from the NEB were compared with those from the open surgery that followed. In 14 cases (17.9%) there was disagreement on the pathology. Of these cases, a meaningful mismatch, in which the erroneous NEB pathology could have led to an inappropriate management decision, occurred in 9 cases (11.5%). Most of these meaningful mismatches were lesions diagnosed as low-grade or pilocytic astrocytoma on the NEB and later proved to be high-grade astrocytoma (4 cases) and 1 case each of meningioma, cavernoma, primitive neuroectodermal tumor, neurocysticercosis, and pineocytoma. Conclusions. In experienced hands, NEBs can be performed with low morbidity and mortality, providing meaningful pathological data for the majority of patients with a wide range of tumor types, locations, and presentations. These biopsies also offer other advantages, such as the ability to perform concomitant endoscopic third ventriculostomy and septum pellucidotomy. However, due caution must be maintained, since pathology obtained from an NEB, as with stereotactic biopsies, may be subject to sampling errors, especially when the results seem to indicate a low-grade glial tumor.

AB - Object. Analysis of the safety and morbidity of neuroendoscopic biopsies (NEBs), as well as the reliability in obtaining an accurate diagnosis, has until now been based on studies with relatively small sample sizes. Through the cooperative efforts of several international medical centers, authors of the present study collected data on a large number of patients to obtain better insight into this issue. When possible, they compared pathology obtained through an NEB with the "gold-standard" pathology obtained in open surgery. Methods. Thirteen randomly chosen medical centers in 9 countries collected data for patients who had undergone NEB, which were then analyzed for universal complications, bleeding, navigation technique, pathology, mismatch between biopsy results and final diagnosis, and a number of other potentially influential factors. Results. Data for 293 patients were analyzed. Sixty percent of the patients were male, and patient ages ranged from 0.1 to 78.7 years (median age 20.4 years). The most common tumor locations were pineal (33.1%), thalamic (16.7%), tectal (13%), and hypothalamic (4.4%). Fifty percent of the tumors were larger than 20 mm, 36% were between 10 and 20 mm, and 14% were smaller than 10 mm. Intraoperative bleeding was seen in 275 patients (94%). The amount of blood was noted as mild in 75%, moderate in 13%, and severe in 6%. Infection occurred in 8 patients (3%). Death occurred in 1 patient (0.3%), which was caused by severe intraoperative bleeding. Biopsies were informative in 265 patients (90.4%). Seventy-eight patients (26.6%) had open surgery following the NEB. For these patients, the pathology results from the NEB were compared with those from the open surgery that followed. In 14 cases (17.9%) there was disagreement on the pathology. Of these cases, a meaningful mismatch, in which the erroneous NEB pathology could have led to an inappropriate management decision, occurred in 9 cases (11.5%). Most of these meaningful mismatches were lesions diagnosed as low-grade or pilocytic astrocytoma on the NEB and later proved to be high-grade astrocytoma (4 cases) and 1 case each of meningioma, cavernoma, primitive neuroectodermal tumor, neurocysticercosis, and pineocytoma. Conclusions. In experienced hands, NEBs can be performed with low morbidity and mortality, providing meaningful pathological data for the majority of patients with a wide range of tumor types, locations, and presentations. These biopsies also offer other advantages, such as the ability to perform concomitant endoscopic third ventriculostomy and septum pellucidotomy. However, due caution must be maintained, since pathology obtained from an NEB, as with stereotactic biopsies, may be subject to sampling errors, especially when the results seem to indicate a low-grade glial tumor.

KW - Brain tumor

KW - Endoscopy

KW - Neuroendoscopic biopsy

KW - Neuropathology

KW - Stereotactic biopsy

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