Contemporary approaches to stereotactic biopsy of central nervous system tumors: challenges of non-diagnostic results

Background. Modern neuro-oncology requires morphological and molecular genetic verification of central nervous system tumors to determine the optimal treatment strategy. Despite the high information yield of neuroimaging methods, a definitive diagnosis in most cases can only be established based on histological tissue examination. Stereotactic biopsy (STB) is a minimally invasive method for obtaining diagnostic material; however, the problem of uninformative results remains clinically significant.

Aim. To assess the diagnostic effectiveness and identify the main causes of non-diagnostic results of STB in patients with brain tumors.

Materials and methods. A retrospective analysis of 172 STB performed at the National Medical Research Center of Neurosurgery named after Academician N.N. Burdenko in 2023–2024 was conducted. All patients underwent comprehensive neuroimaging (computed tomography and magnetic resonance imaging) as well as histological and molecular genetic examination of the biopsy specimens.

Results. The diagnostic yield of STB was 92.4 % (n = 159) and increased to 95.9 % (n = 165) after repeat histological review. The main cause of non-diagnostic biopsies (n = 7) was technical planning errors, primarily incorrect target selection. The presence of diagnostically significant tumor tissue at intraoperative (frozen-section) examination was statistically significantly associated with the final diagnostic yield of the procedure.

Conclusion. STB remains a highly effective and relatively safe method for obtaining diagnostic material in patients with brain tumors. In the era of modern neuro-oncology, it plays a key role in morphological and molecular verification, which determines treatment strategy. The implementation of intraoperative histological control and the standardization of STB protocols may further improve diagnostic accuracy and procedural reproducibility. 

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