Brain Lesions: To Biopsy or Not To Biopsy. A Single Institution Experience

Objectives: Patients presenting with intracranial lesions represent a diagnostic dilemma. Imaging and laboratory tests lack the specificity needed for decision-making. We aimed to detect what intervention and findings made the study patients eligible for brain biopsy, for observation or for treatment. Methods: From January 2010 to December 2012, electronic medical records of 312 adult patients were selected from the hospital database using key words aimed to identify brain lesions, in two-affiliated tertiary-care, county-based hospitals in Houston, Texas.Decision to biopsy, to observe or to treat brain lesions was the main outcome variable. Clinical, laboratory and imaging information were correlated with the main variable to determine which factors made the need for biopsy more likely. Results:Forty biopsied patients and 272 non-biopsied patients were included. Motor deficit, confusion or coma, single brain lesion, larger than 3 cm, with midline shift and complete ring enhancement made brain biopsy more likely, whereas bilateral brain or cerebellar lesion, presence of subcortical lesions with homogeneous enhancement, and history of cancer with potential for brain metastases made the biopsy less likely. Laboratory tests evaluated were inadequate surrogates of brain histology, whereas abnormalities on chest X ray or CT of the chest, abdomen or pelvis made the probability of brain biopsy lower. The above predictors for biopsy were not present among our HIV positive patients. Conclusions: The path from lesion finding to the decision to observe, to treat or to biopsy was heterogeneous. Prospective validation and generalization to other institutions are needed to strengthen our observations.