MRI-guided Stereotactic Biopsy Of Pediatric Diffuse Intrinsic Pontine Glioma:Retrospective Analysis Of A Single-Center

Objective The primary aim is to evaluate the effectiveness and safety of MRI-guided stereotactic biopsy in pediatric diffuse intrinsic pontine gliomas(DIPG),and to explore the clinical value of the biopsy means in the diagnosis of pediatric DIPG.Method A retrospective analysis was performed on the basis of our database of the children who underwent stereotactic biopsy for brain stem lesions,at the Chinese PLA General Hospital-Sixth Medical Center,from January 2014 to December 2018.The tissue samples were obtained via MRI-guided stereotactic biopsy.Based on the inclusion and exclusion criteria,a total of 66 patients included and evaluated in this study who comprised 17 males and 17 females,aged from 2 to 17 years,median age 7.5 years.General information of the patients,imaging characteristics,surgical procedures,histopathology and molecular neuropathology were reviewed.Univariate analysis was performed with ?2 test,Fishers exact test and Mann-Whitney U test,and multivariate logistic regression analysis was performed to analyze the risk factors affecting the diagnostic yield and surgical morbidity.Result A total of sixty-six cases were identified,and the final histopathological diagnosis was made in sixty-two children with four non-diagnostic cases,93.9% for diagnostic yield.Anaplastic astrocytoma WHO ? was diagnosed in twenty-seven,diffuse astrocytoma WHO ? in twenty-three,glioblastoma WHO ? in seven,anaplastic oligodendroglioma WHO ? in two,one patient suffered from pilocytic astrocytoma WHO ?,primitive neuroectodermal tumor(PNET)and gangliocytoma WHO ? were diagnosed in one patient each.Surgery related complications occurred in nine patients,13.6 % for morbidity.In three patients(4.5%),hemorrhage was detected based on postoperative computed tomography,with one asymptomatic hemorrhage and two symptomatic hemorrhage.The factors that may influence the diagnostic yield and surgical morbidity were analyzed by means of univariate analysis,which showed gender(p=0.742),age(p = 0.725),lesion enhancement(p =0.816),biopsy method(p = 0.563)had no significant effects on the diagnostic yield,however,the duration of symptoms and approach had significant effects on the diagnostic yield,and gender(p=0.252),age(p = 0.955),duration of symptoms(0.572),lesion enhancement(p=0.085),biopsy method(p=1.000),approach(0.134)had no significant effects on morbidity.And the results of a multivariate logistic regression analysis showed the approach(p=0.034,OR=17.868)was the main risk factor affecting stereotactic biopsy diagnostic yield that the suboccipital trans-cerebellar approach may provide better diagnostic yield than the trans-frontal approach,whereas,the duration of symptoms was not the main risk factor affecting stereotactic biopsy diagnostic yield.Conclusion Empirical radiation and chemotherapy of DIPG,the conventional therapy options,based on imaging features,had great limitations.Stereotactic biopsy in DIPG allowed for high diagnostic yield,safety and reliability,which can effectively guide further treatments.Biopsy method was not the risk factor affecting stereotactic biopsy diagnostic yield and morbidity,and even if frame or frameless robot-assisted stereotactic biopsy could be safely and effectively performed in pediatric brain stem tumors.The biopsy approach was the main risk factor affecting diagnostic yield that the suboccipital trans-cerebellar approach may provide better diagnostic yield.The identification of histopathology and molecular biology information might pave the new way for individual treatment and the targeted therapy of pediatric DIPG.