Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Histopathological Diagnosis of Primary Central Nervous System Lymphoma After Preoperative Corticosteroid Therapy

Julia Feldheim
,
Marvin Darkwah Oppong
,
Jonas Alexander Feldheim
,
Ramazan Jabbarli
ORCID logo ,
Philipp Dammann
,
Anne-Kathrin Uerschels
,
Oliver Gembruch
ORCID logo ,
Yahya Ahmadipour
ORCID logo ,
Cornelius Deuschl
ORCID logo ,
Andreas Junker
ORCID logo ,
Ulrich Sure
ORCID logo ,
Karsten Henning Wrede
*
Version 1 : Received: 20 February 2024 / Approved: 21 February 2024 / Online: 21 February 2024 (04:02:28 CET)

A peer-reviewed article of this Preprint also exists.

Feldheim, J.; Darkwah Oppong, M.; Feldheim, J.A.; Jabbarli, R.; Dammann, P.; Uerschels, A.-K.; Gembruch, O.; Ahmadipour, Y.; Deuschl, C.; Junker, A.; Sure, U.; Wrede, K.H. Histopathological Diagnosis of Primary Central Nervous System Lymphoma after Therapy with Corticosteroids or Anticoagulants. Cancers 2024, 16, 1157. Feldheim, J.; Darkwah Oppong, M.; Feldheim, J.A.; Jabbarli, R.; Dammann, P.; Uerschels, A.-K.; Gembruch, O.; Ahmadipour, Y.; Deuschl, C.; Junker, A.; Sure, U.; Wrede, K.H. Histopathological Diagnosis of Primary Central Nervous System Lymphoma after Therapy with Corticosteroids or Anticoagulants. Cancers 2024, 16, 1157.

Abstract

In patients with primary central nervous system lymphoma (PCNSL), the choice of surgical strategy for histopathologic assessment is still controversial, particularly in terms of preoperative corticosteroid (CS) therapy. To provide further evidence for clinical decision-making, we retrospectively analyzed data from 148 consecutive patients who underwent surgery at our institution. Although patients treated with corticosteroids preoperatively were significantly more likely to require a second or third biopsy (p=0.049), it was only necessary in less than 10% of the cases with preoperative corticosteroid treatment. The choice of surgical procedure did not affect diagnostic accuracy (p>0.05). Preoperative CSF sampling did not provide additional information but was associated with delayed surgery (p=0.02). Surprisingly, diagnostic accuracy was significantly lower when patients were treated with anticoagulation or dual antiplatelet therapy (p=0.015). In conclusion, preoperative CS therapy can challenge the histological diagnosis of PCNSL. At the same time, our data suggest that preoperative CS treatment only presents a relative contraindication for an early surgical intervention. The standard surgical approach is stereotactic biopsy, but other approaches can be individually considered. If a definitive diagnosis cannot be made after the first surgical intervention, the timing of a repeat biopsy after discontinuation of CS remains a case-by-case decision.

Keywords

primary central nervous system lymphoma; stereotactic biopsy; corticosteroid; histopathology; brain tumor

Subject

Medicine and Pharmacology, Clinical Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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