Comparison of Frame-Based Versus Frameless Intracranial Stereotactic Biopsy

Systematic Review and Meta-Analysis

Sanjay Dhawan, Yuyu He, Jiri Bartek, Ali A. Alattar, Clark C Chen

Research output: Contribution to journalReview article

Abstract

Background: Frame-based stereotaxy has generally been considered the reference standard for brain biopsies. However, frameless stereotaxy might expedite the efficiency of the clinical work flow. Conflicting findings have been reported regarding the relative efficacy and safety of frame-based and frameless needle biopsy of brain lesions. We performed a meta-analysis of the reported data to compare the relative efficacy, safety, and time efficiency of frame-based and frameless stereotactic needle biopsy. Methods: The PubMed database was searched for studies comparing frame-based and frameless biopsy. Of the 5248 reports found, 15 were included in the present meta-analysis. Results: The 15 studies included in the present meta-analysis included 2400 patients. Our analysis found no statistically significant differences between frame-based and frameless biopsy in the diagnostic yield (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.71–1.41), morbidity (OR, 1.13; 95% CI, 0.76–1.66), mortality (OR, 0.94; 95% CI, 0.40–2.17), postbiopsy hemorrhage (OR, 1.16; 95% CI, 0.68–1.96), and postbiopsy neurological deficit (OR, 1.01; 95% CI, 0.62–1.65). The results from our integrated analysis indicated that frameless biopsies are associated with a shorter procedural time relative to frame-based biopsy (standard difference in the mean, 0.64; 95% CI, 0.24–1.04; P = 0.002; I2 [Higgins inconsistency index] = 86.66%). Conclusions: The results from our meta-analysis suggest no significant differences exist between frame-based and frameless biopsy in diagnostic yield, morbidity, and mortality. Frameless biopsy is associated with shorter procedural times relative to frame-based biopsy. We have also discussed the relative merits of frame-based and frameless biopsies.

Original languageEnglish (US)
Pages (from-to)607-616.e4
JournalWorld neurosurgery
Volume127
DOIs
StatePublished - Jul 1 2019

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Meta-Analysis
Biopsy
Confidence Intervals
Odds Ratio
Needle Biopsy
Neuronavigation
Morbidity
Safety
Workflow
Mortality
Brain
PubMed
Databases
Hemorrhage

Keywords

  • Biopsy
  • Frame-based
  • Frameless
  • Neurosurgery
  • Stereotactic

PubMed: MeSH publication types

  • Journal Article
  • Review

Cite this

Comparison of Frame-Based Versus Frameless Intracranial Stereotactic Biopsy : Systematic Review and Meta-Analysis. / Dhawan, Sanjay; He, Yuyu; Bartek, Jiri; Alattar, Ali A.; Chen, Clark C.

In: World neurosurgery, Vol. 127, 01.07.2019, p. 607-616.e4.

Research output: Contribution to journalReview article

Dhawan, Sanjay ; He, Yuyu ; Bartek, Jiri ; Alattar, Ali A. ; Chen, Clark C. / Comparison of Frame-Based Versus Frameless Intracranial Stereotactic Biopsy : Systematic Review and Meta-Analysis. In: World neurosurgery. 2019 ; Vol. 127. pp. 607-616.e4.
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abstract = "Background: Frame-based stereotaxy has generally been considered the reference standard for brain biopsies. However, frameless stereotaxy might expedite the efficiency of the clinical work flow. Conflicting findings have been reported regarding the relative efficacy and safety of frame-based and frameless needle biopsy of brain lesions. We performed a meta-analysis of the reported data to compare the relative efficacy, safety, and time efficiency of frame-based and frameless stereotactic needle biopsy. Methods: The PubMed database was searched for studies comparing frame-based and frameless biopsy. Of the 5248 reports found, 15 were included in the present meta-analysis. Results: The 15 studies included in the present meta-analysis included 2400 patients. Our analysis found no statistically significant differences between frame-based and frameless biopsy in the diagnostic yield (odds ratio [OR], 1.01; 95{\%} confidence interval [CI], 0.71–1.41), morbidity (OR, 1.13; 95{\%} CI, 0.76–1.66), mortality (OR, 0.94; 95{\%} CI, 0.40–2.17), postbiopsy hemorrhage (OR, 1.16; 95{\%} CI, 0.68–1.96), and postbiopsy neurological deficit (OR, 1.01; 95{\%} CI, 0.62–1.65). The results from our integrated analysis indicated that frameless biopsies are associated with a shorter procedural time relative to frame-based biopsy (standard difference in the mean, 0.64; 95{\%} CI, 0.24–1.04; P = 0.002; I2 [Higgins inconsistency index] = 86.66{\%}). Conclusions: The results from our meta-analysis suggest no significant differences exist between frame-based and frameless biopsy in diagnostic yield, morbidity, and mortality. Frameless biopsy is associated with shorter procedural times relative to frame-based biopsy. We have also discussed the relative merits of frame-based and frameless biopsies.",
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T1 - Comparison of Frame-Based Versus Frameless Intracranial Stereotactic Biopsy

T2 - Systematic Review and Meta-Analysis

AU - Dhawan, Sanjay

AU - He, Yuyu

AU - Bartek, Jiri

AU - Alattar, Ali A.

AU - Chen, Clark C

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Frame-based stereotaxy has generally been considered the reference standard for brain biopsies. However, frameless stereotaxy might expedite the efficiency of the clinical work flow. Conflicting findings have been reported regarding the relative efficacy and safety of frame-based and frameless needle biopsy of brain lesions. We performed a meta-analysis of the reported data to compare the relative efficacy, safety, and time efficiency of frame-based and frameless stereotactic needle biopsy. Methods: The PubMed database was searched for studies comparing frame-based and frameless biopsy. Of the 5248 reports found, 15 were included in the present meta-analysis. Results: The 15 studies included in the present meta-analysis included 2400 patients. Our analysis found no statistically significant differences between frame-based and frameless biopsy in the diagnostic yield (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.71–1.41), morbidity (OR, 1.13; 95% CI, 0.76–1.66), mortality (OR, 0.94; 95% CI, 0.40–2.17), postbiopsy hemorrhage (OR, 1.16; 95% CI, 0.68–1.96), and postbiopsy neurological deficit (OR, 1.01; 95% CI, 0.62–1.65). The results from our integrated analysis indicated that frameless biopsies are associated with a shorter procedural time relative to frame-based biopsy (standard difference in the mean, 0.64; 95% CI, 0.24–1.04; P = 0.002; I2 [Higgins inconsistency index] = 86.66%). Conclusions: The results from our meta-analysis suggest no significant differences exist between frame-based and frameless biopsy in diagnostic yield, morbidity, and mortality. Frameless biopsy is associated with shorter procedural times relative to frame-based biopsy. We have also discussed the relative merits of frame-based and frameless biopsies.

AB - Background: Frame-based stereotaxy has generally been considered the reference standard for brain biopsies. However, frameless stereotaxy might expedite the efficiency of the clinical work flow. Conflicting findings have been reported regarding the relative efficacy and safety of frame-based and frameless needle biopsy of brain lesions. We performed a meta-analysis of the reported data to compare the relative efficacy, safety, and time efficiency of frame-based and frameless stereotactic needle biopsy. Methods: The PubMed database was searched for studies comparing frame-based and frameless biopsy. Of the 5248 reports found, 15 were included in the present meta-analysis. Results: The 15 studies included in the present meta-analysis included 2400 patients. Our analysis found no statistically significant differences between frame-based and frameless biopsy in the diagnostic yield (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.71–1.41), morbidity (OR, 1.13; 95% CI, 0.76–1.66), mortality (OR, 0.94; 95% CI, 0.40–2.17), postbiopsy hemorrhage (OR, 1.16; 95% CI, 0.68–1.96), and postbiopsy neurological deficit (OR, 1.01; 95% CI, 0.62–1.65). The results from our integrated analysis indicated that frameless biopsies are associated with a shorter procedural time relative to frame-based biopsy (standard difference in the mean, 0.64; 95% CI, 0.24–1.04; P = 0.002; I2 [Higgins inconsistency index] = 86.66%). Conclusions: The results from our meta-analysis suggest no significant differences exist between frame-based and frameless biopsy in diagnostic yield, morbidity, and mortality. Frameless biopsy is associated with shorter procedural times relative to frame-based biopsy. We have also discussed the relative merits of frame-based and frameless biopsies.

KW - Biopsy

KW - Frame-based

KW - Frameless

KW - Neurosurgery

KW - Stereotactic

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