Petrzelka, Sichova, Majovsky, Svoboda, Sedlak, Soukup, Komarc, Kazda, Netuka
Definitive histology was diagnostic in 97.6% of 85 biopsies. Re-biopsy during the same procedure was required in 3.5% of patients, repeat biopsy under separate general anesthesia was necessary in one case. iMRI demonstrated higher sensitivity (96.4% vs. 68.7%) and negative predictive value (25.0% vs. 3.7%) compared to iHE. No significant difference in diagnostic yield was observed between biopsies performed with or without intraoperative adjuncts. Median overall survival in the high-grade glioma cohort was 4.0 months and associated with ECOG performance status.
UNLABELLED: Stereotactic biopsy remains the diagnostic gold standard for diffuse gliomas in patients unsuitable for surgical resection. Despite the high precision stereotactic techniques, intraoperative MRI (iMRI) and histological examination (iHE) are used to verify targeting accuracy and biopsy yield during surgery.
RESEARCH QUESTION: This study aimed to compare the predictive value of iMRI and iHE for achieving diagnostic biopsy yield in frameless stereotactic biopsy of suspected diffuse glioma.
MATERIAL AND METHODS: We retrospectively analyzed patients who underwent frameless stereotactic biopsy using the VarioGuide system (BrainLab AG, Germany) at the MilitaryUniversityHospital Prague between April 2012 and February 2025. Patients with definitive diagnosis of diffuse glioma and intraoperative adjunct examinations during surgery were included. Sensitivity, specificity, positive predictive value, and negative predictive value of iMRI and iHE were evaluated. Secondary objectives included operative duration, overall survival, and comparison with CNS lymphoma biopsies.
RESULTS: Definitive histology was diagnostic in 97.6% of 85 biopsies. Re-biopsy during the same procedure was required in 3.5% of patients, repeat biopsy under separate general anesthesia was necessary in one case. iMRI demonstrated higher sensitivity (96.4% vs. 68.7%) and negative predictive value (25.0% vs. 3.7%) compared to iHE. No significant difference in diagnostic yield was observed between biopsies performed with or without intraoperative adjuncts. Median overall survival in the high-grade glioma cohort was 4.0 months and associated with ECOG performance status.
DISCUSSION: Despite high accuracy of frameless stereotactic system, iMRI and iHE proved useful for intraoperative prediction of diagnostic biopsy yield. iMRI may additionally provide detection of possible perioperative complications. Poor survival outcomes reflected the unfavorable clinical status of this biopsy-only cohort.