Low-Grade Glioma on Stereotactic Biopsy: How Often is the Diagnosis Accurate?

Y. Muragaki; M. Chernov; T. Maruyama; T. Ochiai; T. Taira; O. Kubo; R. Nakamura; H. Iseki; T. Hori; K. Takakura

doi:10.1055/s-0028-1082322

min - Minimally Invasive Neurosurgery, Table of Contents

Minim Invasive Neurosurg 2008; 51(5): 275-279
DOI: 10.1055/s-0028-1082322

Original Article

Low-Grade Glioma on Stereotactic Biopsy: How Often is the Diagnosis Accurate?

Y. Muragaki¹ ^, ² , M. Chernov³ , T. Maruyama¹ , T. Ochiai¹ , T. Taira¹ , O. Kubo¹ , R. Nakamura² ^, ³ , H. Iseki¹ ^, ² ^, ³ , T. Hori¹ , K. Takakura¹ ^, ² ^, ³

¹Department of Neurosurgery, Neurological Institute, Tokyo Women’s Medical University, Tokyo, Japan
²Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, Tokyo, Japan
³International Research and Educational Institute for Integrated Medical Sciences (IREIIMS), Tokyo Women’s Medical University, Tokyo, Japan

Abstract

The objective of the present study was an evaluation of the incidence and risk factors for erroneous histopathological diagnosis of low-grade glioma after stereotactic biopsy. Twenty-eight tumors diagnosed as low-grade glioma after stereotactic biopsy and surgically resected thereafter were analyzed. There were 13 astrocytomas, 7 oligodendrogliomas, and 8 mixed gliomas. All neoplasms had a lobar location. Seven tumors had contrast enhancement on MRI. The number of tissue samples obtained during stereotactic biopsy was one in 19 cases, two in 4, and three or more in 5. Complete diagnostic agreement in tumor typing and grading after stereotactic biopsy and surgical resection was attained in 10 cases (36%). Agreement in tumor typing was marked in 16 cases (57%). Erroneous typing was more frequent in tumors with an MIB-1 index of less than 3% (P=0.0629) and mixed gliomas (P=0.0801). Overgrading of WHO grade I tumors was marked in 3 cases (11%) and undergrading of WHO grade III gliomas in 8 cases (28%). Tumor undergrading was more frequent in cases with an MIB-1 index of more than 3% (P=0.0045). The MIB-1 index detected after stereotactic biopsy was nearly always lower compared with those established after surgical resection (P<0.0001). In conclusion, the histopathological diagnosis of low-grade glioma established after stereotactic biopsy is associated with a substantial risk of inaccuracy. Tumors with low proliferative activity and mixed gliomas are especially susceptible for erroneous tumor typing. Undergrading of high-grade gliomas may be suspected if the MIB-1 index in the tumor specimen constitutes more, than 3%.

Key words

stereotactic biopsy - diagnostic accuracy - low-grade glioma - MIB-1 index

Full Text

References

1 Chandrasoma PT, Smith MM, Apuzzo MLJ. Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurgery. 1989; 24 160-165
2 Revesz T, Scaravilli F, Coutinho L. et al . Reliability of histological diagnosis including grading in gliomas biopsied by image-guided stereotactic technique. Brain. 1993; 116 781-793
3 Kim JE, Kim DG, Paek SH. et al . Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment. Acta Neurochir (Wien). 2003; 145 547-555
4 Glantz MJ, Burger PC, Herndon JE II. et al . Influence of the type of surgery on the histologic diagnosis in patients with anaplastic gliomas. Neurology. 1991; 41 1741-1744
5 Grunert P, Ungersbock K, Bohl J. et al . Results of 200 intracranial stereotactic biopsies. Neurosurg Rev. 1994; 17 59-66
6 Vaquero J, Martinez R, Manrique M. Stereotactic biopsy for brain tumors: is it always necessary?. Surg Neurol. 2000; 53 432-438
7 Jackson RJ, Fuller GN, Abi-Said D. et al . Limitations of stereotactic biopsy in the initial management of gliomas. Neurooncology. 2001; 3 193-200
8 MacGirt MJ, Villavicencio AT, Bulsara KR. et al . MRI-guided stereotactic biopsy in the diagnosis of glioma: comparison of biopsy and surgical resection specimen. Surg Neurol. 2003; 59 277-282
9 Kleihues P, Cavenee WK. eds. Pathology and genetics of tumours of the Nervous System. Lyon: IARC Press 2000
10 Mork SJ, Halvorsen TB, Lindegaard K-F. et al . Oligodendroglioma: histologic evaluation and prognosis. J Neuropathol Exp Neurol. 1986; 45 65-78
11 Aker FV, Hakan T, Karadereler S. et al . Accuracy and diagnostic yield of stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimens. Neuropathology. 2005; 25 207-213
12 Okamoto Y, Patre PL Di, Burkhard C. et al . Population-based study on incidence, survival rates, and genetic alterations of low-grade diffuse astrocytomas and oligodendrogliomas. Acta Neuropathol (Berl). 2004; 108 49-56
13 Ohgaki H, Kleihues P. Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol. 2005; 64 479-489
14 Krouwer HCJ, Duinen SG van, Kamphorst W. et al . Oligoastrocytomas: a clinicopathological study of 52 cases. J Neurooncol. 1997; 33 223-238
15 Grier JT, Batchelor T. Low-grade gliomas in adults. Oncologist. 2006; 11 681-693
16 Lebrun C, Fontaine D, Bourg V. et al . Treatment of newly diagnosed symptomatic pure low-grade oligodendrogliomas with PCV chemotherapy. Eur J Neurol. 2007; 14 391-398
17 Dean BL, Drayer BP, Bird CR. et al . Gliomas: classification with MR imaging. Radiology. 1990; 174 411-415
18 Law M, Yang S, Wang H. et al . Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. AJNR Am J Neuroradiol. 2003; 24 1989-1998
19 Kondziolka D, Lunsford LD, Martinez AJ. Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma. J Neurosurg. 1993; 79 533-536
20 Barker FG II, Chang SM, Huhn SL. et al . Age and the risk of anaplasia in magnetic resonance-nonenhancing supratentorial cerebral tumors. Cancer. 1997; 80 936-941
21 Ginsberg LE, Fuller GN, Hashmi M. et al . The significance of lack of MR contrast enhancement of supratentorial brain tumors in adults: histopathological evaluation of a series. Surg Neurol. 1998; 49 436-440
22 Scott JN, Brasher PMA, Sevick RJ. et al . How often are nonenhancing supratentorial gliomas malignant? A population study. Neurology. 2002; 59 947-949
23 Buckner JC, Gesme Jr D, O`Fallon JR. et al . Phase II trial of procarbazine, lomustine, and vincristine as initial therapy for patients with low-grade oligodendroglioma or oligoastrocytoma: efficacy and associations with chromosomal abnormalities. J Clin Oncol. 2003; 21 251-255
24 Massager N, David P, Goldman S. et al . Combined magnetic resonance imaging- and positron emission tomography-guided stereotactic biopsy in brainstem mass lesions: diagnostic yield in a series of 30 patients. J Neurosurg. 2000; 93 951-957
25 Maia Jr ACM, Malheiros SMF, da Rocha AJ. et al . Stereotactic biopsy guidance in adults with supratentorial nonenhancing gliomas: role of perfusion-weighted magnetic resonance imaging. J Neurosurg. 2004; 101 970-976
26 Floeth FW, Pauleit D, Wittsack H-J. et al . Multimodal metabolic imaging of cerebral gliomas: positron emission tomography with [¹⁸F] fluoro-ethyl-L-tyrosine and magnetic resonance spectroscopy. J Neurosurg. 2005; 102 318-327
27 Kelly PJ, Daumas-Duport C, Kispert DB. et al . Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg. 1987; 66 865-874
28 Plunkett R, Allison RR, Grand W. Stereotactic neurosurgical biopsy is an underutilized modality. Neurosurg Rev. 1999; 22 117-120
29 Yu X, Liu Z, Tian Z. et al . Stereotactic biopsy for intracranial space-occupying lesions: clinical analysis of 550 cases. Stereotact Funct Neurosurg. 2000; 75 103-108
30 Kim L, Hochberg FH, Thornton AF. et al . Procarbazine, lomustine, and vincristine (PCV) chemotherapy for Grade III and Grade IV oligoastrocytomas. J Neurosurg. 1996; 85 602-607
31 Blaauw G, Braakman R. Pitfalls in diagnostic stereotactic brain surgery. Acta Neurochir Suppl. 1988; 42 161-165
32 Feiden W, Steude U, Bise K. et al . Accuracy of stereotactic brain tumor biopsy: comparison of the histologic findings in biopsy cylinders and resected tumor tissue. Neurosurg Rev. 1991; 14 51-56
33 Soo TM, Bernstein M, Provias J. et al . Failed stereotactic biopsy in a series of 518 cases. Stereotact Funct Neurosurg. 1996; 64 183-196
34 Coons SW, Johnson PC. Regional heterogeneity in the proliferative activity of human gliomas as measured by the Ki-67 labeling index. J Neuropathol Exp Neurol. 1993; 52 609-618
35 Mittler MA, Walters BC, Stopa EG. Observer reliability in histological grading of astrocytoma stereotactic biopsies. J Neurosurg. 1996; 85 1091-1094
36 Daumas-Duport C, Scheithauer B, O`Fallon J. et al . Grading of astrocytomas: a simple and reproducible method. Cancer. 1988; 62 2152-2165
37 Hemm S, Vayssiere N, Zanca M. et al . Thallium SPECT-based stereotactic targeting for brain tumor biopsies. Stereotact Funct Neurosurg. 2004; 82 70-76
38 Son BC, Kim MC, Choi BG. et al . Proton magnetic resonance chemical shift imaging (1 H CSI)-directed stereotactic biopsy. Acta Neurochir (Wien). 2001; 143 45-50
39 Hall WA, Truwit CL. 1.5 T spectroscopy-supported brain biopsy. Neurosurg Clin N Am. 2005; 16 165-172

Correspondence

Y. MuragakiMD, PhD

Faculty of Advanced Techno-Surgery

Institute of Advanced Biomedical Engineering and Science

Graduate School of Medicine

Tokyo Women’s Medical University

8-1 Kawada-cho

Shinjuku-ku

Tokyo 162-8666

Japan

Phone: +81/3/3353 81 11 ext.399 89

Fax: +81/3/5361 77 96

Email: ymuragaki@abmes.twmu.ac.jp