Correlation of diagnostic yield of stereotactic brain biopsy with number of biopsy bits and site of the lesion

Our objective was to examine the reliability of histological diagnosis achieved vis a vis the number of biopsy bits obtained along a single trajectory of the stereotactic needle. A retrospective analysis of stereotactic biopsies performed in a single tertiary care neurosciences center, during a period of 11 years, between 1995 to 2005 was done. The overall diagnostic accuracy achieved on histopathology was correlated with the number of bits obtained by stereotactic biopsy. A total of 86 cases were analyzed, which consisted of 58 males and 28 females. Age ranged from 6 to 75 years, with a mean age of 36.1 years. Twenty percent of the patients were in the pediatric age group and 15% were ≥60 years of age. Most common sites biopsied were thalamus/basal ganglia (55.8%), followed by eloquent areas and other sites. A definitive histological diagnosis was established in 70 cases (diagnostic yield, 81.3%), which encompassed 65 neoplastic and 5 nonneoplastic lesions. Astrocytic lesions, the most common, include 10 pilocytic astrocytomas (PA), 29 diffuse astrocytomas (DA), 11 anaplastic astrocytomas (AA), and 7 glioblastoma multiforme (GBM). In 16 cases no definite histological diagnosis could be offered. The number of biopsies ranged between 1 and 6 bits (mean, 2; median, 1). The majority (68.7%) of the biopsies were 1 or 2-bits. The diagnostic accuracy increased from 76.5% for single biopsies to 84% and 88.2% for 2 and 3 bits, respectively, and 100% for biopsies with 5 to 6 bits. Overall, a trend of higher diagnostic yield was seen in cases with more biopsies when compared with single bit biopsies. Thus, this small series confirms that stereotactic procedures involving multiple bits are associated with a high diagnostic yield