Neurological diseases of unknown etiology: Brain-biopsy diagnostic yields and safety.

Biopsy Brain / diagnostic imaging Humans Odds Ratio Retrospective Studies
Brain lesion Cryptogenic neurological disease Diagnostic workup Neuropathology Neurosurgery

Journal

European journal of internal medicine
ISSN: 1879-0828
Titre abrégé: Eur J Intern Med
Pays: Netherlands
ID NLM: 9003220

Informations de publication

Date de publication:
10 2020
Historique:
received: 16 03 2020
revised: 04 05 2020
accepted: 16 05 2020
pubmed: 14 7 2020
medline: 16 2 2021
entrez: 14 7 2020
Statut: ppublish

Résumé

For nonneoplastic neurological diseases, no recommendation exists regarding the place or appropriate timing of brain biopsy. The aim of this study was to evaluate the diagnostic yield and safety of brain biopsies from patients with neurological diseases of unknown etiology. We performed a retrospective cohort study from January 1, 2008 to December 31, 2018. We analyzed 1847 brain-biopsied patients, including 178 biopsies indicated for neurological diseases of unknown etiology. Specific histological and final diagnosis rates, positive diagnosis-associated factors, complication rate and complication-associated factors were assessed. Specific histological diagnosis and final diagnosis rates were 71.3% and 83.1%, respectively, leading to therapeutic management change(s) for 75.3% of patients. Brain- biopsy-related mortality and permanent neurological morbidity occurred in 1.1% and 0.6% of the patients, respectively. The multivariable logistic-regression model retained (odds ratio [95% CI] only immunodepression (2.2 [1.1-4.7]; P=.04) as being independently associated with specific histological diagnosis, while supratentorial biopsy-targeted lesions (4.1 [1.1-15.2]; P=.04) were independently associated with a final diagnosis. Biopsies obtained from comatose patients were less contributive to the diagnosis (0.2 [0.05-0.7]; P=.01). Prebiopsy platelet count <100 G/L (28.5 [1.8-447]; P=.02), hydrocephalus (6.3 [1.2-15.3]; P=.02) and targeted lesions <1 cm (4.3 [1.2-15.3]; P=.03) were independently associated with brain biopsy-related complications. For highly selected patients with neurological diseases of unknown etiology, brain biopsy has a high diagnostic yield and low frequency of severe complications. We advocate that this procedure be considered early in the diagnosis algorithm of these patients.

Sections du résumé

BACKGROUND
For nonneoplastic neurological diseases, no recommendation exists regarding the place or appropriate timing of brain biopsy. The aim of this study was to evaluate the diagnostic yield and safety of brain biopsies from patients with neurological diseases of unknown etiology.
METHODS
We performed a retrospective cohort study from January 1, 2008 to December 31, 2018. We analyzed 1847 brain-biopsied patients, including 178 biopsies indicated for neurological diseases of unknown etiology. Specific histological and final diagnosis rates, positive diagnosis-associated factors, complication rate and complication-associated factors were assessed.
RESULTS
Specific histological diagnosis and final diagnosis rates were 71.3% and 83.1%, respectively, leading to therapeutic management change(s) for 75.3% of patients. Brain- biopsy-related mortality and permanent neurological morbidity occurred in 1.1% and 0.6% of the patients, respectively. The multivariable logistic-regression model retained (odds ratio [95% CI] only immunodepression (2.2 [1.1-4.7]; P=.04) as being independently associated with specific histological diagnosis, while supratentorial biopsy-targeted lesions (4.1 [1.1-15.2]; P=.04) were independently associated with a final diagnosis. Biopsies obtained from comatose patients were less contributive to the diagnosis (0.2 [0.05-0.7]; P=.01). Prebiopsy platelet count <100 G/L (28.5 [1.8-447]; P=.02), hydrocephalus (6.3 [1.2-15.3]; P=.02) and targeted lesions <1 cm (4.3 [1.2-15.3]; P=.03) were independently associated with brain biopsy-related complications.
CONCLUSION
For highly selected patients with neurological diseases of unknown etiology, brain biopsy has a high diagnostic yield and low frequency of severe complications. We advocate that this procedure be considered early in the diagnosis algorithm of these patients.

Identifiants

DOI: 10.1016/j.ejim.2020.05.029 PMID: 32654880
pubmed: 32654880
pii: S0953-6205(20)30214-4
doi: 10.1016/j.ejim.2020.05.029
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

78-85

Investigateurs

Alexandre Carpentier (A)
Laurent Capelle (L)
Soledad Navarro (S)
Olivier Benveniste (O)
Dimitri Psimaras (D)
Khê Hoang-Xuan (K)
Jean-Yves Delattre (JY)
Nicolas Weiss (N)
Clémence Marois (C)
Sarah Benghanem (S)
Nadine Martin-Duverneuil (N)
Véronique Leblond (V)
Sylvain Choquet (S)
Charles-Edouard Luyt (CE)
Alain Combes (A)
Eric Caumes (E)
Vincent Calvez (V)
Aude Jary (A)
Renaud Piarroux (R)
Alexandra Aubry (A)
Vincent Degos (V)
Alice Jacquens (A)
Caroline Papeix (C)
Vincent Navarro (V)

Informations de copyright

Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare no conflicts of interest.

Auteurs

Bertrand Mathon (B)

AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013, Paris, France; Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; Institut du Cerveau et de la Moelle Epinière (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France. Electronic address: bertrand.mathon@aphp.fr.

Alexandre Le Joncour (A)

AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Médecine Interne et d'Immunologie Clinique, F-75013, Paris, France.

Franck Bielle (F)

Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; Institut du Cerveau et de la Moelle Epinière (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France; AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Neuropathologie, F-75013, Paris, France.

Karima Mokhtari (K)

AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Neuropathologie, F-75013, Paris, France.

Anne-Laure Boch (AL)

AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013, Paris, France.

Matthieu Peyre (M)

AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013, Paris, France; Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; Institut du Cerveau et de la Moelle Epinière (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.

Zahir Amoura (Z)

Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, F-75013, Paris, France.

Patrice Cacoub (P)

Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Médecine Interne et d'Immunologie Clinique, F-75013, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; Département d'Inflammation-Immunopathologie-Biothérapie (DHU i2B), UMR 7211, Sorbonne Université, F-75005, Paris, France.

Nadia Younan (N)

Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Neuro-Oncologie, F-75013, Paris, France.

Sophie Demeret (S)

AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Département de neurologie, Unité de Médecine Intensive Réanimation Neurologique, F-75013, Paris, France.

Eimad Shotar (E)

AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013, Paris, France.

Sonia Burrel (S)

Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Virologie, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), F-75013, Paris, France.

Arnaud Fekkar (A)

AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Parasitologie, F-75013, Paris, France.

Jérôme Robert (J)

Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Laboratoire de Bactériologie, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, and INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, F-75013, Paris, France.

Aymeric Amelot (A)

AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013, Paris, France; Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France.

Marc Pineton de Chambrun (M)

Sorbonne Université, UPMC Univ. Paris 06, F-75005, Paris, France; AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, F-75013, Paris, France; AP-HP, Hôpitaux Universitaires La Pitié-Salpêtrière - Charles Foix, Institut de Cardiométabolisme et Nutrition (ICAN), Service de Médecine Intensive-Réanimation, F-75013, Paris, France.

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Classifications MeSH

questionsmedicales.fr › Techniques d'investigation › Techniques cytologiques › Cytodiagnostic › Biopsie › Neurological diseases of unknown etiology:...
questionsmedicales.fr › Système nerveux › Système nerveux central › Encéphale › Neurological diseases of unknown etiology:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Neurological diseases of unknown etiology:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Odds ratio › Neurological diseases of unknown etiology:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Neurological diseases of unknown etiology:...