Influence of preoperative corticosteroid treatment on rate of diagnostic surgeries in primary central nervous system lymphoma: a multicenter retrospective study

Florian Scheichel, Franz Marhold, Daniel Pinggera, Barbara Kiesel, Tobias Rossmann, Branko Popadic, Adelheid Woehrer, Michael Weber, Melitta Kitzwoegerer, Klaus Geissler, Astrid Dopita, Stefan Oberndorfer, Wolfgang Pfisterer, Christian F Freyschlag, Georg Widhalm, Karl Ungersboeck, Karl Roessler

Research output: Journal article (peer-reviewed)Journal article

2 Citations (Scopus)

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.

Original languageEnglish
Article number754
Pages (from-to)754
JournalBMC Cancer
Volume21
Issue number1
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Adrenal Cortex Hormones/pharmacology
  • Adult
  • Aged
  • Aged, 80 and over
  • Central Nervous System Neoplasms/pathology
  • Female
  • Humans
  • Lymphoma/pathology
  • Male
  • Middle Aged
  • Preoperative Period
  • Retrospective Studies
  • Young Adult

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