The molecular diagnostic yield of frame-based stereotactic biopsies in the age of precision neuro-oncology: a cross-sectional study

• Published in: Acta neurochirurgica Vol. 165; no. 9; pp. 2479 - 2487
• Main Authors: Alhalabi, Obada T., Sahm, Felix, Unterberg, Andreas W., Jakobs, Martin
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.09.2023; Springer Nature B.V
• Subjects: Biopsy; Cross-sectional studies; Diagnosis; Functional Neurosurgery – Other; Glioma; Inflammatory diseases; Interventional Radiology; Lymphoma; Medicine; Medicine & Public Health; Metastases; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Oncology; Original; Original Article; Surgical Orthopedics; Tumors; Stereotactic biopsy; Glioma; Molecular genetics; Precision oncology
• DOI: 10.1007/s00701-023-05742-z
• ISSN: 0942-0940; 0001-6268

Purpose With the increasing role of molecular genetics in the diagnostics of intracranial tumors, delivering sufficient representative tissue for such analyses is of paramount importance. This study explored the rate of successful diagnosis after frame-based stereotactic biopsies of intracranial lesions. Methods Consecutive patients undergoing frame-based stereotactic biopsies in 2020 and 2021 were included in this retrospective analysis. Cases were classified into three groups: conclusive, diagnosis with missing molecular genetics (MG) data, and inconclusive neuropathological diagnosis. Results Of 145 patients, a conclusive diagnosis was possible in n  = 137 cases (94.5%). For 3 cases (2.0%), diagnosis was established with missing MG data. In 5 cases (3.5%), an inconclusive (tumor) diagnosis was met. Diagnoses comprised mainly WHO 4 glioblastomas ( n  = 73, 56%), CNS lymphomas ( n  = 23, 16%), inflammatory diseases ( n  = 14, 10%), and metastases ( n  = 5, 3%). Methylomics were applied in 49% ( n  = 44) of tumor cases (panel sequencing in n  = 28, 30% of tumors). The average number of specimens used for MG diagnostics was 5, while the average number of specimens provided was 15. In a univariate analysis, insufficient DNA was associated with an inconclusive diagnosis or a diagnosis with missing MG data ( p  < 0.001). Analyses of planned and implemented trajectories of cases with diagnosis with missing MG data or inconclusive diagnosis ( n  = 8) revealed that regions of interest were reached in almost all cases ( n  = 7). Conclusion Although stereotactic frame-based biopsies deliver a limited amount of tissue, they bear high histopathological and molecular genetic diagnostic yields. Given the proven surgical precision of the planned biopsy trajectories, optimizing surveyed lesion regions could help improve the rate of conclusive diagnoses.