Minimizing the risks of stereotactic brain biopsy in suspected central nervous system lymphoma: a retrospective database study

Stereotactic brain biopsy is widely used to confirm the diagnosis of central nervous system (CNS) lymphoma; however, few studies have investigated the perioperative factors that impact the procedure’s clinical utility and outcome. We retrospectively reviewed all patients at our institution who underwent brain biopsy and were confirmed to have CNS lymphoma diagnosis in years 2001–2021. Clinical history, imaging, intraoperative data, and post-biopsy outcomes were obtained. Associations between perioperative factors and postprocedural morbidity/mortality were analyzed using univariate and multivariate models. CNS lymphomas were diagnosed in 75 patients via 79 separate biopsies, of which 12 (16%) had a prior diagnosis of lymphoma (CNS or systemic). Postoperative 30-day mortality was 8.9%. Intraoperative bleeding was noted in 6 patients (7.6%), postoperative hemorrhage in 4 patients (5.1%). We identified several factors leading to poor outcomes. Biopsy of deep-brain structures (thalamus and basal ganglia) was associated with higher rates of postoperative hemorrhage (17.6% vs. 1.6%, p = 0.030) and discharge to hospice (35.3% vs. 9.7%, p = 0.018). Biopsy at multiple depths, a modifiable risk factor, was associated with worse survival after multivariate analysis (p = 0.036). In patients with a history of systemic diffuse large B-cell lymphoma (DLBCL), all brain biopsies diagnosed DLBCL; several patients with non-DLBCL were diagnosed with other pathologies including glioblastoma. Several variables were associated with poor outcomes after biopsy for suspected CNS lymphoma. Our findings support avoiding biopsy of multiple depths unless critical. These factors should be considered and further risk stratification for patient selection is necessary to optimize the clinical utility of brain biopsy.