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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1989 Jul;52(7):821–825. doi: 10.1136/jnnp.52.7.821

Computed tomography in the diagnosis of malignant brain tumours: do all patients require biopsy?

M S Choksey 1, A Valentine 1, H Shawdon 1, C E Freer 1, K W Lindsay 1
PMCID: PMC1031926  PMID: 2769273

Abstract

A proportion of patients with computed tomographic (CT) scan appearances of malignant brain tumour undergo conservative management, despite the absence of histological confirmation of the diagnosis. Concern that this policy risked misdiagnosing a benign tumour prompted us to examine the accuracy of CT scanning in diagnosing malignant lesions. The study was designed to determine whether within a group of 300 patients with intracerebral mass lesions of known pathology, two sub-groups existed: one with appearances so specific for malignant glioma that biopsy was unnecessary, and the other in which the appearances were characteristic of malignancy, though not specific for glioma. Three neuroradiologists independently reviewed the CT scans, together with brief clinical details. When diagnosing malignant tumours, all made errors: nine benign lesions were considered to be malignant. When diagnosing malignant glioma, one neuroradiologist made errors, but the other two adopted a more cautious approach and were accurate. The restricted a "certain" diagnosis to about one in five scans considered to show malignant tumour. Those diagnosed specifically as malignant glioma were intrinsic, irregular, mixed density lesions, exhibiting variable enhancement and infiltrating the peri-ventricular tissues, especially the corpus callosum. Using these criteria, they could correctly identify a small proportion of patients with malignant gliomas. In all other patients, biopsy remains the only means of obtaining a definitive diagnosis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ashby M. A., Bowen D., Bleehen N. M., Barber P. C., Freer C. E. Primary lymphoma of the central nervous system: experience at Addenbrooke's Hospital, Cambridge. Clin Radiol. 1988 Mar;39(2):173–181. doi: 10.1016/s0009-9260(88)80019-9. [DOI] [PubMed] [Google Scholar]
  2. Baker H. L., Jr, Houser O. W., Campbell J. K. National Cancer Institute study: evaluation of computed tomography in the diagnosis of intracranial neoplasms. I. Overall results. Radiology. 1980 Jul;136(1):91–96. doi: 10.1148/radiology.136.1.7384529. [DOI] [PubMed] [Google Scholar]
  3. Hochberg F. H., Miller D. C. Primary central nervous system lymphoma. J Neurosurg. 1988 Jun;68(6):835–853. doi: 10.3171/jns.1988.68.6.0835. [DOI] [PubMed] [Google Scholar]
  4. Kendall B. E., Jakubowski J., Pullicino P., Symon L. Difficulties in diagnosis of supratentorial gliomas by CAT scan. J Neurol Neurosurg Psychiatry. 1979 Jun;42(6):485–492. doi: 10.1136/jnnp.42.6.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Marshall L. F., Jennett B., Langfitt T. W. Needle biopsy for the diagnosis of malignant glioma. JAMA. 1974 Jun 10;228(11):1417–1418. [PubMed] [Google Scholar]
  6. McNeil B. J., Hanley J. A., Funkenstein H. H., Wallman J. Paired receiver operating characteristic curves and the effect of history on radiographic interpretation. CT of the head as a case study. Radiology. 1983 Oct;149(1):75–77. doi: 10.1148/radiology.149.1.6611955. [DOI] [PubMed] [Google Scholar]
  7. Salcman M. Survival in glioblastoma: historical perspective. Neurosurgery. 1980 Nov;7(5):435–439. doi: 10.1227/00006123-198011000-00001. [DOI] [PubMed] [Google Scholar]
  8. Shetter A. G., Bertuccini T. V., Pittman H. W. Closed needle biopsy in the diagnosis of intracranial mass lesions. Surg Neurol. 1977 Nov;8(5):341–345. [PubMed] [Google Scholar]
  9. Wroe S. J., Foy P. M., Shaw M. D., Williams I. R., Chadwick D. W., West C., Towns G. Differences between neurological and neurosurgical approaches in the management of malignant brain tumours. Br Med J (Clin Res Ed) 1986 Oct 18;293(6553):1015–1018. doi: 10.1136/bmj.293.6553.1015. [DOI] [PMC free article] [PubMed] [Google Scholar]

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