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Stereotactic Brain Biopsy in Human Immunodeficiency Virus—Infected Patients

Roberto Luzzati, MD; Sergio Ferrari, MD; Antonio Nicolato, MD; Enrico Piovan, MD; Marina Malena, MD; Mara Merighi, MD; Michela Morbin, MD; Massimo Gerosa, MD; Nicolo' Rizzuto, MD; Ercole Concia,, MD
Arch Intern Med. 1996;156(5):565-568. doi:10.1001/archinte.1996.00440050123013.
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Objective:  To evaluate prospectively the diagnostic efficacy and safety of stereotactic brain biopsy and its impact on treatment, outcome, and survival in human immunodeficiency virus—infected patients with focal brain lesions.

Methods:  Computed tomography—guided stereotactic brain biopsy was performed in 26 patients, of whom 17 failed to respond to a 2- to 3-week anti-Toxoplasma regimen. Exclusion criteria for biopsy were overt acquired immunodeficiency syndrome for 2 years or longer, Karnofsky score less than 50, and severe coagulopathies.

Results:  A definitive diagnosis was obtained in 24 patients (92%), of whom 12 (46%) had primary brain lymphoma, six (23%) had progressive multifocal leukoencephalopathy, and four (15%) had Toxoplasma encephalitis. Two thirds of contrast-enhancing lesions on computed tomography were lymphoma and three fourths of contrast-negative lesions were leukoencephalopathy. Three patients had biopsy-related cerebral hemorrhages (morbidity, 11.5%). Median follow-up and survival for the entire group were 24 weeks (range, 6 to 135 weeks). Twenty patients (77%) received specific therapy and 13 (50%) responded to treatment. Of 11 patients with lymphoma undergoing irradiation treatment (whole-brain radiotherapy in seven and γ-knife treatment in four), nine (82%) had clinical and radiologic response, with a median survival of 34 weeks (range, 13 to 57 weeks).

Conclusions:  Stereotactic brain biopsy has high diagnostic efficacy and clinical benefit in carefully selected human immunodeficiency virus—infected patients. The procedure should be performed essentially in patients with contrast-enhancing lesions on computed tomography who have a high frequency of treatable cerebral diseases.(Arch Intern Med. 1996;156:565-568)


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