Diagnostic impact of preoperative corticosteroids in primary central nervous system lymphoma

Carli L. Bullis, Ashlie Maldonado-Perez, Stephen G. Bowden, Nasser Yaghi, Daniel Munger, Matthew D. Wood, Prakash Ambady, Edward A. Neuwelt, Seunggu J. Han

Research output: Contribution to journalArticle

Abstract

Purpose: High dose corticosteroids are an effective tool for rapidly alleviating neurologic symptoms caused by intracranial mass lesions. However, there is concern that preoperative corticosteroids limit the ability to obtain a definitive pathologic diagnosis, particularly if imaging features suggest primary central nervous system lymphoma (PCNSL). Methods: To explore the impact of preoperative corticosteroids in newly diagnosed PCNSL patients, from 2009 to 2018 treated at our institution. Results: We identified 54 patients; 18 had received corticosteroids prior to biopsy or resection. Only in one case did the patient have a prior non-diagnostic biopsy, requiring a second procedure. The cumulative doses of preoperative dexamethasone ranged from 4 mg to 120 mg (mean 32 mg, median 24 mg), given over 1–14 days (mean 2 days, median 1 day), and the majority had received corticosteroids for only 1–2 days. There was a trend for a larger diameter of lesional T1 contrast enhancement for patients who received steroids (39 mm vs. 34 mm, p = 0.11). In this series of cases with pathologically and clinically proven PCNSL, preoperative corticosteroids had been given in a third of cases, suggesting that they may be given for symptomatic relief without compromising pathologic diagnosis. Conclusions: Despite the commonly held tenet that preoperative corticosteroids can obscure the pathologic diagnosis in PCNSL, this is likely not the case in the majority of patients who receive a short course preoperatively. Obtaining a second stereotactic scan to confirm continued presence of the lesion prior to tissue sampling may also mitigate these concerns.

Original languageEnglish (US)
JournalJournal of Clinical Neuroscience
DOIs
StateAccepted/In press - Jan 1 2019

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Keywords

  • Corticosteroid
  • Diagnosis
  • Pathology
  • PCNSL
  • Primary CNS lymphoma

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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