Improving Diagnostic Yield and Accuracy of Stereotactic Biopsies through Changes in Practice and Techniques: An...

Background  Stereotactic biopsies are used to aid neurosurgeons in clinching the diagnosis of intracranial lesions that are difficult to access surgically. A published study of stereotactic biopsies in our center demonstrated a diagnostic yield of only 76% for biopsies from the year 2014 to 2019. A set of criteria/prerequisites was applied to increase yield. Objective  The aim of the study was to identify the improvement in accuracy and yield after implementation of a set of criteria/prerequisites. Materials and Methods  This was a retrospective and prospective analysis of all patients who underwent stereotactic biopsies from the year 2014 to 2022. This study was conducted at Sarawak General Hospital, Malaysia. A set of stereotactic criteria/prerequisites was introduced since 2020, which include preoperative careful, meticulous trajectory planning and target selection, regular checking and maintenance of equipment, larger burr holes, and good sampling techniques. Results  A total of 83 patients underwent stereotactic biopsies from the year 2014 to 2022. Frameless and frame-based methods were used for 45 (54%) and 38 (46%) patients, respectively. The overall diagnostic yield of all biopsies was 84%. Fifty patients underwent stereotactic biopsies prior to implementation of good practice guidelines in 2020 with a positive histopathological yield and accuracy of 76 and 88%, respectively. Thirty-three biopsies done postimplementation demonstrated a yield and accuracy of 97% ( p  < 0.05). There was also a shift of preference toward frame-based methods after 2019, with 85% of these biopsies being frame based. Conclusion  This comparative study shows that adherence to specific stereotactic biopsy guidelines and techniques introduced in our center has successfully improved our biopsy yield and accuracy.