Stereotactic biopsy for brain tumors: Is it always necessary?

BACKGROUND Stereotactic biopsy is currently being used in oncological neuro surgery despite its limitations. The purpose of this study is to compare it s diagnostic reliability with that of the diagnosis based on clinical data and neuroimaging techniques. METHODS We studied 200 patients (134 men and 66 women) who underwent 212 st ereotactic biopsy procedures to assess brain tumors. All were subjected to CT scan and 71 patients also underwent MRI. A presumptive diagnosis of brai n tumor was established in each case and the findings compared with the res ults of stereotactic biopsy and the clinical course. RESULTS A clear presumptive diagnosis was established before stereotactic b iopsy in 90% of the patients, and in 95% of this group, the diagnosis was c onfirmed by the biopsy and/or the clinical course. The stereotactic biopsy modified the presumptive diagnosis in eight patients (4%), without changing the clinical diagnosis of malignant lesion. In our present series, 10% of the procedures were of no help in determining a diagnosis and in 7% of pati ents, the stereotactic biopsy led to diagnostic errors that influenced the therapeutic management and resulted in an erroneous prognosis. CONCLUSIONS These data confirm the need for clinical correlation with the f indings obtained at stereotactic biopsy and suggest that stereotactic biops y may not always be useful or necessary in the management of brain tumor pa tients. According to our present critical analysis, when a clear presumptiv e diagnosis of brain tumor can be made, it may be sufficient to base the ma nagement of the patient only on clinical and neuroimaging findings. (C) 200 0 by Elsevier Science Inc.