Artikel
Diagnostic value and safety of stereotactic biopsy for brainstem tumors: a systematic review and meta-analysis of 1480 cases
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Autoren
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Philipp Kickingereder
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
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Peter Willeit
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Thorsten Simon
- Department of Pediatric Hematology and Oncology, University Hospital of Cologne, Cologne, Germany
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Maximilian I. Ruge
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
Text
Objective: The feasibility and particularly safety of stereotactic biopsy for brainstem tumors (BSTs) are still controversial. Although MRI has been reported as the preferred diagnostic tool, histopathological analysis is frequently necessary to establish a definitive diagnosis. Moreover, recent advances in molecular characterization of brainstem gliomas – accounting for the majority of BSTs – have revealed several potential targets for molecular-based therapies. Hence a molecular stereotactic biopsy that combines histopathological diagnosis with molecular-genetic analysis will become increasingly important for patients with BSTs. We conducted a systemic review and meta-analysis to precisely determine the risks and benefits of stereotactic biopsy for BSTs.
Method: A systematic search in PubMed, EMBASE and the Web of Science yielded 3766 potentially eligible abstracts. Meta-analysis was conducted on 38 studies describing 1480 biopsy procedures for BSTs. Primary outcome measures were diagnostic success and procedure-related complications of the procedure. Data were analyzed according to standard meta-analytic techniques.
Results: The weighted average proportions across the analyzed studies were: 96.2% (95%CI: 94.5-97.6%) for a diagnostic success, 7.8% (95%CI: 5.6-10.2%) for overall morbidity, 1.7% (95%CI: 0.9-2.7%) for permanent morbidity, and 0.9% (95%CI: 0.5-1.4%) for mortality. Meta regression revealed a significant correlation between diagnostic success rates and the number of biopsy procedures performed annually in each center (p=0.011). Other factors did not affect the outcome measures.
Conclusions: Stereotactic biopsy of BSTs is safe. It allows exact histopathological diagnosis as a prerequisite for adequate treatment and opens new perspectives for the molecular characterization of these tumors as a crucial first step towards more individualized treatment concepts.
