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Brain, Vol. 116, No. 4, 781-793, 1993
© 1993 Guarantors of Brain

research-article

Reliability of histological diagnosis including grading in gliomas biopsied by image-guided stereotactic technique

Tamas Revesz1, Francesco Scaravilli1, Ligia Coutinho1, Hazel Cockburn2, Peter Sacares3 and David G. T. Thomas2

1Departments of Neuropathology London, UK 2Departments of Neurological Surgery London, UK 3Departments of Computing and Statistics Unit, Institute of Neurology London, UK

Correspondence to: Correspondence to Dr T Reveaz, Department of Neuropathology, Institute of Neurology, Queen Square, London WCIN 3BG, UK

We report clinical and pathological data of 419 image-guided stereotactic biopsies. In the present series the diagnostic yield, estimated by comparing the original histological diagnoses with follow-up data, was found to be ~ 94% in gliomas. As it has been suggested that malignancy of astrocytic gliomas may be considerably underestimated in the small tissue samples obtained by stereotactic biopsy, we have reviewed 160 adult, diffuse supratentorial astrocytic tumours, correlating the original Kernohan tumour grades with survival. In this grading system, although there was generally a good correlation between histological grade and survival probability (P < 0.0001), no distinction could be made between the grade 3 (anaplastic astrocytoma) and grade 4 (glioblastoma) groups. Tumour grades obtained by applying the criteria of the more recent Daumas-Duport grading system were also determined and correlated with survival. These latter tumour grades not only correlated well with survival (P < 0.0001), but also enabled us to identify a group of patients with intermediate grade malignancy (grade 3, anaplastic astrocytoma), surviving longer than those with grade 4 tumours. Image-guided stereotactic biopsy is a useful means of providing tissue samples for histological diagnosis of brain neoplasms, including gliomas. Histological grading of adult, diffuse supratentorial astrocytic glioma diagnosed by this technique is possible and should be carried out using an appropriate grading system.

Received November 26, 1992. Revised January 28, 1993. Accepted March 23, 1993.


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