PDF(Pubmed)
Abstract：
In patients with primary central nervous system lymphoma (PCNSL), the choice of surgical strategy for histopathologic assessments 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 (but discontinued) corticosteroid treatment. Surprisingly, diagnostic accuracy was significantly lower when patients were treated with anticoagulation or dual antiplatelet therapy (p = 0.015). Preoperative CSF sampling did not provide additional information but was associated with delayed surgery (p = 0.02). 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 early surgical intervention. If a definitive diagnosis cannot be made after the first surgical intervention, the timing of a repeat biopsy after the discontinuation of CS remains a case-by-case decision. The effect of anticoagulation and dual antiplatelet therapy on diagnostic accuracy might have been underestimated and should be examined closely in future investigations.
摘要：
在原发性中枢神经系统淋巴瘤（PCNSL）患者中，组织病理学评估的手术策略的选择仍然存在争议，特别是在术前皮质类固醇（CS）治疗方面。为临床决策提供进一步的证据，我们回顾性分析了在我们机构接受手术的148例连续患者的数据.尽管术前接受皮质类固醇治疗的患者更可能需要第二次或第三次活检（p=0.049），仅在术前(但停止)皮质类固醇治疗的不到10%的病例中,才有必要.令人惊讶的是,当患者接受抗凝治疗或双重抗血小板治疗时,诊断准确率显著降低(p=0.015).术前脑脊液采样没有提供额外信息，但与延迟手术有关（p=0.02）。总之,术前CS治疗可能会挑战PCNSL的组织学诊断。同时,我们的数据表明,术前CS治疗仅是早期手术干预的相对禁忌症.如果在第一次手术干预后无法做出明确诊断，CS停药后重复活检的时间仍然是逐案决定.抗凝和双重抗血小板治疗对诊断准确性的影响可能被低估了，应在未来的研究中仔细检查。
