Florian Scheichel1,2, Franz Marhold3,4, Daniel Pinggera5, Barbara Kiesel6, Tobias Rossmann7,8, Branko Popadic1,2, Adelheid Woehrer9, Michael Weber10, Melitta Kitzwoegerer1,11, Klaus Geissler12, Astrid Dopita13, Stefan Oberndorfer1,14, Wolfgang Pfisterer7, Christian F Freyschlag5, Georg Widhalm6, Karl Ungersboeck1,2, Karl Roessler6. 1. Karl Landsteiner University of Health Sciences, Krems, Austria. 2. Department of Neurosurgery, University Hospital St. Poelten, Dunant-Platz 1, 3100, St. Poelten, Austria. 3. Karl Landsteiner University of Health Sciences, Krems, Austria. franz.marhold@stpoelten.lknoe.at. 4. Department of Neurosurgery, University Hospital St. Poelten, Dunant-Platz 1, 3100, St. Poelten, Austria. franz.marhold@stpoelten.lknoe.at. 5. Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria. 6. Department of Neurosurgery, Medical University Vienna, Vienna, Austria. 7. Department of Neurosurgery, Donauspital SMZ-Ost, Vienna, Austria. 8. Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria. 9. Institute of Neurology, Medical University Vienna, Vienna, Austria. 10. Department of Research Management, Karl Landsteiner University of Health Sciences, Krems, Austria. 11. Department of Pathology, University Hospital St. Poelten, St.Poelten, Austria. 12. Sigmund Freud Private University, Vienna, Austria. 13. Institute for Pathology and Microbiology, Donauspital SMZ-Ost, Vienna, Austria. 14. Department of Neurology, University Hospital St. Poelten, St.Poelten, Austria.
Abstract
BACKGROUND: Corticosteroid therapy (CST) prior to biopsy may hinder histopathological diagnosis in primary central nervous system lymphoma (PCNSL). Therefore, preoperative CST in patients with suspected PCNSL should be avoided if clinically possible. The aim of this study was thus to analyze the difference in the rate of diagnostic surgeries in PCNSL patients with and without preoperative CST. METHODS: A multicenter retrospective study including all immunocompetent patients diagnosed with PCNSL between 1/2004 and 9/2018 at four neurosurgical centers in Austria was conducted and the results were compared to literature. RESULTS: A total of 143 patients were included in this study. All patients showed visible contrast enhancement on preoperative MRI. There was no statistically significant difference in the rate of diagnostic surgeries with and without preoperative CST with 97.1% (68/70) and 97.3% (71/73), respectively (p = 1.0). Tapering and pause of CST did not influence the diagnostic rate. Including our study, there are 788 PCNSL patients described in literature with an odds ratio for inconclusive surgeries after CST of 3.3 (CI 1.7-6.4). CONCLUSIONS: Preoperative CST should be avoided as it seems to diminish the diagnostic rate of biopsy in PCNSL patients. Yet, if CST has been administered preoperatively and there is still a contrast enhancing lesion to target for biopsy, surgeons should try to keep the diagnostic delay to a minimum as the likelihood for acquiring diagnostic tissue seems sufficiently high.
BACKGROUND: Corticosteroid therapy (CST) prior to biopsy may hinder histopathological diagnosis in primary central nervous system lymphoma (PCNSL). Therefore, preoperative CST in patients with suspected PCNSL should be avoided if clinically possible. The aim of this study was thus to analyze the difference in the rate of diagnostic surgeries in PCNSLpatients with and without preoperative CST. METHODS: A multicenter retrospective study including all immunocompetent patients diagnosed with PCNSL between 1/2004 and 9/2018 at four neurosurgical centers in Austria was conducted and the results were compared to literature. RESULTS: A total of 143 patients were included in this study. All patients showed visible contrast enhancement on preoperative MRI. There was no statistically significant difference in the rate of diagnostic surgeries with and without preoperative CST with 97.1% (68/70) and 97.3% (71/73), respectively (p = 1.0). Tapering and pause of CST did not influence the diagnostic rate. Including our study, there are 788 PCNSLpatients described in literature with an odds ratio for inconclusive surgeries after CST of 3.3 (CI 1.7-6.4). CONCLUSIONS: Preoperative CST should be avoided as it seems to diminish the diagnostic rate of biopsy in PCNSLpatients. Yet, if CST has been administered preoperatively and there is still a contrast enhancing lesion to target for biopsy, surgeons should try to keep the diagnostic delay to a minimum as the likelihood for acquiring diagnostic tissue seems sufficiently high.
Entities:
Keywords:
Corticosteroid therapy; Diagnostic rate; Primary central nervous system lymphoma
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