gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Frozen sections in stereotactic biopsies do not improve diagnostic yield

Meeting Abstract

Suche in Medline nach

  • F. Stockhammer - Abteilung für Neurochirurgie, Universität Rostock
  • M. Misch - Klinik für Neurochirurgie, Charité - Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.03.11

DOI: 10.3205/11dgnc124, URN: urn:nbn:de:0183-11dgnc1240

Veröffentlicht: 28. April 2011

© 2011 Stockhammer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Due to multimodal target setting and high technical standards frame based stereotactic biopsies yield high diagnostic accuracy. However, previous reports state intraoperative frozen section (FS) as standard procedure. We prospectively investigated the diagnostic value, skin-to-skin time, morbidity and mortality of stereotactic biopsies omitting frozen sections by a randomized setting.

Methods: 106 consecutive patients were in includes in this prospective trial in two neurosurgical centres. After informed consent and capture of frame based planning scans, patients were randomized to intraoperative FS or termination of the biopsy immediately after obtaining the biopsy sample (non-FS). The randomization was stratified to contrast enhancement of the lesion and neurosurgical centre. The biopsy was defined as not diagnostic, if the final histology was not directive or consistent with the further clinical course.

Results: FS were performed in 50 patients. In 17 patients FS were ambivalent, so we obtained additional biopsies. In 56 patients FS were omitted. In 9 patients (8%) the biopsy was not directive to the patient's clinical course. In detail the non diagnostic specimens revealed reactive changes in 2, gliosis in 4, necrosis in 2 and an astrocytoma WHO grade II in one patient, who died with clinical sign of an high grade glioma two month later. There was no mortality due to the surgical procedure. Thus, the diagnostic yield in the FS was 90% and 93% in the non-FS group (OR 0.69, 95% CI 0.17-2.73). The median skin-to-skin time in the non-FS group was 36 minutes and 68 minutes in the FS group (p < 0.0001, t-test). The groups did not differ concerning number of samples (p = 0.45), postop haemorrhage (p = 0.78), morbidity (p = 0.20) and WHO grade of histology (p = 0.69).

Conclusions: Intraoperative frozen section in frame based stereotactic biopsy does not improve the diagnostic yield, but significantly prolongs the duration of surgery.