Aurélien Viaccoz1, François Ducray1, Yannick Tholance1, Gleicy Keli Barcelos1, Laure Thomas-Maisonneuve1, Hervé Ghesquières1, David Meyronet1, Isabelle Quadrio1, Stéphanie Cartalat-Carel1, Guy Louis-Tisserand1, Emmanuel Jouanneau1, Jacques Guyotat1, Jérôme Honnorat1, Armand Perret-Liaudet1. 1. Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.).
Abstract
BACKGROUND: The diagnosis of primary central nervous system lymphoma (PCNSL) can be challenging. PCNSL lesions are frequently located deep within the brain, and performing a cerebral biopsy is not always feasible. The aim of this study was to investigate the diagnostic value of CSF neopterin, a marker of neuroinflammation, in immunocompetent patients with suspected PCNSL. METHODS: We retrospectively reviewed the characteristics of 124 patients with brain tumor (n = 82) or an inflammatory CNS disorder (n = 42) in whom CSF neopterin levels were assessed. Twenty-eight patients had PCNSL, 54 patients had another type of brain tumor (glioma n = 36, metastasis n = 13, other n = 5), and 13 patients had a pseudotumoral inflammatory brain lesion. RESULTS: CSF neopterin levels were significantly higher in the patients with PCNSL than in those with other brain tumors (41.8 vs 5.1 nmol/L, P < .001), those with pseudotumoral inflammatory brain lesions (41.8 vs 4.3 nmol/L, P < .001), and those with nontumefactive inflammatory CNS disorders (41.8 vs 3.8 nmol/L, P < .001). In the 95 patients with space-occupying brain lesions, at a cutoff of 10 nmol/L, the sensitivity of this approach was 96% and the specificity was 93% for the diagnosis of PCNSL. The positive and negative predictive values were 84% and 98%, respectively. CONCLUSION: Assessing CSF neopterin levels in patients with a suspected brain tumor might be helpful for the positive and differential diagnosis of PCNSL. A prospective study is warranted to confirm these results.
BACKGROUND: The diagnosis of primary central nervous system lymphoma (PCNSL) can be challenging. PCNSL lesions are frequently located deep within the brain, and performing a cerebral biopsy is not always feasible. The aim of this study was to investigate the diagnostic value of CSFneopterin, a marker of neuroinflammation, in immunocompetent patients with suspected PCNSL. METHODS: We retrospectively reviewed the characteristics of 124 patients with brain tumor (n = 82) or an inflammatory CNS disorder (n = 42) in whom CSFneopterin levels were assessed. Twenty-eight patients had PCNSL, 54 patients had another type of brain tumor (glioma n = 36, metastasis n = 13, other n = 5), and 13 patients had a pseudotumoral inflammatory brain lesion. RESULTS:CSFneopterin levels were significantly higher in the patients with PCNSL than in those with other brain tumors (41.8 vs 5.1 nmol/L, P < .001), those with pseudotumoral inflammatory brain lesions (41.8 vs 4.3 nmol/L, P < .001), and those with nontumefactive inflammatory CNS disorders (41.8 vs 3.8 nmol/L, P < .001). In the 95 patients with space-occupying brain lesions, at a cutoff of 10 nmol/L, the sensitivity of this approach was 96% and the specificity was 93% for the diagnosis of PCNSL. The positive and negative predictive values were 84% and 98%, respectively. CONCLUSION: Assessing CSFneopterin levels in patients with a suspected brain tumor might be helpful for the positive and differential diagnosis of PCNSL. A prospective study is warranted to confirm these results.
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