gms | German Medical Science

Objective: Application of glucocorticoids (GC) in patients with suspected primary central nervous system lymphoma (PCNSL) carries the risk of a diagnostic error. Goal of this retrospective study was to evaluate the effect of GC application on the diagnostic yield.

Method: 60 patients (between 2009 and 2015) underwent diagnostic procedures with pathologies suspicious of PCNSL based on radiological findings, GC were discontinued if possible at least for 6 days. Patients without GC underwent surgery/biopsy immediately. Patients with bad or worsening general condition underwent surgery/biopsy during GC treatment.

Results: Histopathologically, PCNSL was found in 46 of the 60 patients. Procedures for histopathological diagnosis were open biopsy in 7 patients (15%), and stereotactic biopsy in 39 patients (85%). 10 patients (22%) underwent surgery during GC therapy, 12 (26%) patients received GC before surgery with discontinuation for at least 6 days. 24 patients (52%) underwent surgery without GC. No histopathological diagnosis was found in one (1.6%), and other histological diagnosis could be found in 11 (18.3%) patients. The patient without histopathological diagnosis underwent stereotactic biopsy after discontinuation of GC, however, in follow-up imaging studies the lesion was not visible and he has no diagnosis in follow-up since 48 months.

Conclusions: In our single center series 59 of 60 patients had a confirmed diagnosis after the procedure, 46 of which were PCNSL The missing diagnosis is unclear since 48 months. We therefore conclude that the use of GC should be determined by clinical circumstance and necessity rather than concern of obscuring PCNSL diagnosis.