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
Affiliations
Florian Scheichel
Karl Landsteiner University of Health Sciences
Franz Marhold
Karl Landsteiner University of Health Sciences
Daniel Pinggera
Department of Neurosurgery, Medical University of Innsbruck
Barbara Kiesel
Department of Neurosurgery, Medical University Vienna
Tobias Rossmann
Department of Neurosurgery, Donauspital SMZ-Ost
Branko Popadic
Karl Landsteiner University of Health Sciences
Adelheid Woehrer
Institute of Neurology, Medical University Vienna
Michael Weber
Department of Research Management, Karl Landsteiner University of Health Sciences
Melitta Kitzwoegerer
Karl Landsteiner University of Health Sciences
Klaus Geissler
Sigmund Freud Private University
Astrid Dopita
Institute for Pathology and Microbiology, Donauspital SMZ-Ost
Stefan Oberndorfer
Karl Landsteiner University of Health Sciences
Wolfgang Pfisterer
Department of Neurosurgery, Donauspital SMZ-Ost
Christian F. Freyschlag
Department of Neurosurgery, Medical University of Innsbruck
Georg Widhalm
Department of Neurosurgery, Medical University Vienna
Karl Ungersboeck
Karl Landsteiner University of Health Sciences
Karl Roessler
Department of Neurosurgery, Medical University Vienna
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.
