title: Diagnostic Value and Safety of Stereotactic Biopsy in Acquired Immune Deficiency Syndrome Patients with Intracranial Lesions: Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To evaluate the diagnostic value and safety of stereotactic biopsy in acquired immune deficiency syndrome (AIDS) patients with intracranial lesions via meta-analysis.
  
  
  METHODS
  Relevant cohort studies were identified through a literature search in PubMed, Embase, and Ovid from 1985 to October 1, 2016. Appropriate studies were identified per search criteria. Systematic review and meta-analysis were used to assess the diagnostic success rate, changed management rate, clinical improvement rate, mortality rate, morbidity rate, hemorrhage rate, hemorrhage in morbidity rate, and final histologic diagnosis results. Study-specific outcomes were combined per a random effects model. Outcomes were compared between the pre-highly active antiretroviral therapy (HAART) and post-HAART groups. Correlations between outcomes were assessed via meta-regression analysis.
  
  
  RESULTS
  A total of 19 cohort studies with 820 patients were included in this meta-analysis. The weighted proportions per the random effects model were 92.2% (95% confidence interval [CI; 89.3%-94.5%]) for diagnostic success rate, 5.1% (95% CI [2.5%-8.3%]) for morbidity, and 0.7% (95% CI [0%-1.9%]) for mortality. The most common procedure-related morbidity was hemorrhage at 3.3% (95% CI [1.1%-6.3%]). Hemorrhage in morbidity was 78.0% (95% CI [51.4%-97.4%]). Management changed and clinical improvement were 60.4% (95% CI [49.4%-71.0%]) and 34.0% (95% CI [22.2%-46.8%]), respectively. The 4 most common diagnoses were primary central nervous system lymphoma (27.8%; 95% CI [20.2%-36.1%]), progressive multifocal leukoencephalopathy (PML) (21.0%; 95% CI [14.3%-28.4%]), toxoplasma encephalitis (TE) (20.3%; 95% CI [14.3%-27.0%]), and human immunodeficiency virus (HIV) encephalitis (4.1%; 95% CI [1.4%-7.6%]). Multiple diagnoses rate was 1.2% (95% CI [0.0%-3.6%]). HIV encephalitis rate was significantly higher in the post-HAART group than the pre-HAART group (17.9% vs. 3.2%, respectively; P = 0.0024).
  
  
  CONCLUSIONS
  Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patients with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. The 4 most common intracranial lesions in patients with AIDS are lymphoma, PML, TE, and HIV encephalitis.
authors.affiliation: Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Jibo
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Xuemeng
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Fu
authors.affiliation: Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Chengshi
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Gong
authors.affiliation: Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Guo
authors.affiliation: Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Jincao
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China. Electronic address: jiaoxiadeidea@163.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy / Q000473:pathology*; D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000473:pathology; D023241:Antiretroviral Therapy, Highly Active; D001706:Biopsy / Q000379:methods; D001921:Brain / Q000473:pathology*; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications / Q000473:pathology; D008297:Male; D061214:Patient Safety; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed; D016781:Toxoplasmosis, Cerebral / Q000150:complications / Q000473:pathology
keywords: AIDS; HAART; Intracranial lesion; Stereotactic biopsy