title: Brain biopsy in patients with acquired immunodeficiency syndrome: diagnostic value, clinical performance, and survival time.
abstract: BACKGROUND
  Despite extensive discussion in recent years, brain biopsy in patients positive for human immunodeficiency virus who manifest cerebral mass lesions remains an ill-defined step in management.
  
  
  METHODS
  Prebiopsy data of 26 human immunodeficiency virus-positive patients with cerebral mass lesions who underwent computed tomography-guided stereotactic brain biopsy (SBB) were reviewed by a specialist in infectious diseases and by a neuroradiologist to establish a clinical diagnosis and a treatment plan for each patient. The postbiopsy diagnosis was compared with the prebiopsy diagnosis. Long-term patient outcome after SBB was recorded by means of a clinical performance scale to estimate its impact on life expectancy and clinical performance.
  
  
  RESULTS
  The SBB was diagnostic in 25 patients (96%). Potentially treatable disease was diagnosed in 21 patients (81%), and specific therapy was initiated in 17 patients (65%); 10 patients (39%) were able to complete therapy. The SBB corroborated the clinical diagnosis in 13 (52%) of 25 patients. The group with identical clinical and biopsy-proved diagnoses showed significantly better response to therapy (P = .02), clinical performance (P = .04), and survival after biopsy (P = .01), as compared with the group with different clinical and biopsy-proved diagnosis, although no significant difference was found for the degree of immunosuppression. Only completion of the treatment plan increased life expectancy significantly (P = .008).
  
  
  CONCLUSIONS
  These data show that in human immunodeficiency virus-positive patients with brain mass lesions, SBB has a high diagnostic yield. A subgroup of patients will benefit from specific therapy guided by the SBB result. The procedure should, however, be strictly limited to patients able to tolerate specific therapy.
authors.affiliation: Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: M W
authors.initials: MW
authors.lastname: Hornef
authors.forename: A
authors.initials: A
authors.lastname: Iten
authors.forename: P
authors.initials: P
authors.lastname: Maeder
authors.forename: J G
authors.initials: JG
authors.lastname: Villemure
authors.forename: L
authors.initials: L
authors.lastname: Regli
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000473:pathology* / Q000628:therapy; D000328:Adult; D001706:Biopsy / Q000379:methods; D001921:Brain / Q000473:pathology / Q000821:virology*; D001927:Brain Diseases / Q000473:pathology / Q000628:therapy / Q000821:virology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed