Artikel
Problematic or practical? Histopathological diagnosis of primary central nervous system lymphoma after preoperative corticosteroid therapy
Problematisch oder praktikabel? Histopathologische Diagnose von primären cerebralen Lymphomen nach präoperativer Kortikosteroidtherapie
Suche in Medline nach
Autoren
Veröffentlicht: | 4. Juni 2021 |
---|
Gliederung
Text
Objective: Primary central nervous system lymphoma (PCNSL) is a rare disease that usually requires a surgical biopsy to verify the diagnosis. High-dose corticosteroids (CS) are an effective symptomatic treatment for PCNSL-patients with severe neurological symptoms. However, CS may disguise the histopathological diagnosis necessitating multiple surgeries. The aim of our study was to investigate the impact of CS treatment on histopathological diagnostic accuracy.
Methods: This retrospective single-centre observational study, comprised all patients diagnosed with PCNSL that were treated at our institution between October 2008 and June 2020. Data extracted from digital patients records included demographics, surgical techniques and treatment with CS before surgery.
Results: 125 patients were included into the analysis. The majority of the patients were male (59.2%), mean age at diagnosis was 54,5 years. Surgical techniques included stereotactic biopsy (n=78), open biopsy (n=20), endoscopic biopsy (n=5), and partial or total tumour resection (n=19). Forty-six patients received CS before the respective neurosurgical intervention. CS treatment was discontinued between 0 to 75 days prior to surgery. PCNSL-diagnosis could be verified in the initial histopathological analysis in 41 (89.1%) patients with CS and in 77 (97.5%) patients without CS (χ² fisher p=0.09), respectively. Six patients were operated on while undergoing CS treatment and in 18 patients, CS treatment was discontinued less than ten days before surgery, rendering histopathological analysis significantly less accurate (success rate of 79%; χ² fisher p=0.003). Patients with unsuccessful initial diagnosis stopped taking CS 4 to 8 days before surgery (n=5) or were not treated with CS (n=2). Interestingly, we did not observe a difference regarding successful tissue sampling between stereotactic and open surgery techniques (χ² fisher p=0.67).
Conclusion: If clinically justifiable, CS should be discontinued ten days before the surgical biopsy to significantly improve diagnostic accuracy. However, even after CS therapy, PCNSL could be diagnosed in almost 90% justifying immediate biopsy in cases where rapid causal therapy is mandatory. A second biopsy ten days after CS therapy appears to be a valid option if the initial diagnosis fails.