Stereotactic Brain Biopsy or Bronchoscopic/Transthoracic Needle Biopsy for Diagnosis of Metastatic Cancer Presenting Simultaneously in Lung and Brain: A Comparison of Safety and Efficacy

Background: When patients present with sim ultaneous lung and brain lesions consistent with metastases, it is often presumed that it is safer and less invasive to biopsy the lung lesion. Objective: To determine whether lung biopsy or stereotactic brain biopsy has a higher diagnostic yield and lower morbidity for tissue diagnosis in patients with simultaneous brain and lung lesions. Methods: Retrospective review of the author’s stereotactic biopsy series and of the literature on brain and lung biopsies for suspected malignancy. Results: The overall diagnostic yield for bronchoscopic lung biopsy ranged from 44% to 88% and the pneumothorax rate from 1.2% to 8%. No deaths were reported. The overall diagnostic yield for transthoracic lung biopsy ranged from 74% to 96% and pneumothorax rate from 2.2% to 8%. No deaths were reported. The overall diagnostic yield for stereotactic brain biopsy ranged from 90.6% to 99.3% when all potential diagnoses are included. Complication rates ranged from 0.6% to 4.8% with mortality from 0% to 1.5%. Several series reported no mortality. Conclusion: Stereotactic brain biopsy has a higher diagnostic yield and a lower complication rate, but a higher mortality. The inclusion of diagnoses other than metastases in the reported series may account for some of the reported mortality. When lung and brain lesions are detected simultaneously, stereotactic biopsy is an excellent option for tissue diagnosis.