Impact of Stereotactic Biopsy in HIV Patients

• Published in: World neurosurgery Vol. 86; pp. 300 - 305
• Main Authors: Quick-Weller, Johanna, Kann, Gerrit, Lescher, Stephanie, Imöhl, Lioba, Seifert, Volker, Weise, Lutz Martin, Brodt, Hans-Reinhard, Marquardt, Gerhard
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2016
• Subjects: Adult; AIDS; Biopsy - adverse effects; Biopsy - methods; Biopsy - mortality; Brain Neoplasms - complications; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Female; HIV; HIV Infections - diagnosis; HIV Infections - mortality; HIV Infections - pathology; Humans; Hypopharynx - pathology; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgery; Pharyngeal Neoplasms - complications; Pharyngeal Neoplasms - pathology; Pharyngeal Neoplasms - surgery; Postoperative Care; Retrospective Studies; Stereotactic biopsy; Stereotaxic Techniques; Tomography, X-Ray Computed; MRI; Acquired immunodeficiency syndrome; AIDS; Stereotactic biopsy; PML; Progressive multifocal leukoencephalopathy; Non-Hodgkin lymphoma; CT; Highly active antiretroviral therapy; NHL; HIV; Computed tomography; Magnetic resonance imaging; STX; Human immunodeficiency virus; HAART
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2015.09.037

Objective During their disease a significant number of human immunodeficiency virus (HIV)-infected patients develop neurologic symptoms due to intracerebral pathologies. Entities commonly found are toxoplasmosis, lymphomas, or progressive multifocal leukoencephalopathy. In some patients, diagnosis is not feasible with imaging alone, requiring biopsy. The objective of this study was to evaluate the impact of stereotactic biopsy in HIV patients on adjustment of therapy. Methods Between January 2004 and May 2015 at our clinic, 26 HIV-infected patients underwent stereotactic biopsy. Thin-layer magnetic resonance images were obtained and fused with computed tomography scans, taken with the stereotactic frame (Leksell) mounted. Biopsy material was evaluated pathologically and microbiologically. Results Histologic analysis revealed B-cell lymphoma in 6 patients (23.1%) and progressive multifocal leukoencephalopathy in 2 patients (7.7%). Abscess and toxoplasmosis were found in 3 patients each (11.5% and 11.5%), and encephalitis occurred in 4 patients (15.4%). In 2 patients each (7.7%), vasculitis, metastasis, and glioblastoma were diagnosed. Further findings comprised non-Hodgkin lymphoma and Burkitt lymphoma in 1 patient each. After biopsy, treatment was significantly changed in 18 (69.2%) patients ( P < 0.01). Antibiotic therapy was adjusted in 6 patients (23.1%), and chemotherapy in 3 patients (16.7%). Other changes included antibiotic/antiviral therapy to chemotherapy in 3 patients (16.7%), chemotherapy to radiation, cortisone to chemotherapy, and aciclovir to cortisone in 1 patient each. One patient with glioblastoma underwent resection, and another patient received radiation. One patient underwent palliative care. Conclusion Stereotactic biopsy in HIV-infected patients results in significant changes of therapy in more than two thirds of the patients.