Clinical Report: Diagnostic Yield of Frame-Based Stereotactic Biopsies in Neuro-Oncology

Overview

This study evaluated 145 consecutive frame-based stereotactic biopsies for unclear intracranial lesions, demonstrating a high diagnostic yield with 91% conclusive neuropathological diagnoses. Molecular genetic analyses were successfully performed in the majority of cases, supporting the integration of molecular diagnostics in routine stereotactic biopsy workflows.

Background

Stereotactic biopsies are a minimally invasive technique used to obtain tissue from deep-seated or eloquent brain lesions that are not amenable to resection. With advances in molecular neuropathology and the 2021 WHO CNS tumor classification, obtaining sufficient tissue for integrated histopathological and molecular diagnosis is critical. This study investigates whether current frame-based stereotactic biopsy techniques provide adequate tissue for comprehensive neuropathological and molecular analyses, which are essential for personalized neuro-oncological therapies.

Data Highlights

Key Findings

• Frame-based stereotactic biopsies yielded a conclusive neuropathological diagnosis in 91% of cases.
• Molecular genetic analyses, including NGS and methylation profiling, were successfully performed on most biopsy specimens.
• Lesions biopsied were predominantly deep-seated or located in eloquent brain regions, with gliomas being the most common diagnosis.
• Only 9% of cases had inconclusive neuropathological diagnoses, indicating high diagnostic reliability.
• Preoperative imaging showed contrast enhancement in 85% of lesions, aiding in trajectory planning and biopsy targeting.
• Biopsy specimens were obtained in a serial fashion along the planned trajectory to optimize tissue yield for molecular studies.

Clinical Implications

Frame-based stereotactic biopsies provide sufficient tissue for integrated histopathological and molecular diagnosis in the majority of patients with unclear intracranial lesions. This supports their continued use in neuro-oncology for diagnosis and personalized therapy planning, even in deep or eloquent brain areas. Optimizing biopsy trajectories and specimen collection can further enhance molecular diagnostic success.

Conclusion

Frame-based stereotactic biopsies demonstrate a high diagnostic yield with adequate tissue for advanced molecular analyses, reinforcing their essential role in precision neuro-oncology. These findings support their use as a minimally invasive, reliable diagnostic tool for complex intracranial lesions.

References

1. WHO Classification of CNS Tumors 2021 -- Molecular and Histopathological Integration
2. Next-Generation Sequencing in Neuro-Oncology Diagnostics
3. Stereotactic Biopsy Techniques and Diagnostic Yield Studies