Chrastina J, Hermanová M, Jančálek R, Feitová V, Hrabovský D, Novák Z
Klin Onkol. 2017 Winter;30(6):437-442. doi: 10.14735/amko2017437.
Backround: Because of the dismal prognosis of untreated brain lymphoma early histological verification using stereobiopsy is decisive for patient with this disease. The study analysed the diagnostic yield of stereobiopsy in brain lymphoma patients with respect to prebiopsy corticosteroid administration.
Patients with brain lymphomas were identified in a group of 162 stereotactic biopsies (108 frame-based and 54 frameless) of patients harboring suspected brain tumor. Non conclusive biopsies were reevaluated to exclude the possibility of missed lymphoma.
Total 9 patients (8.3%) and 4 patients (7.4%) had lymphomas in the frame-based and frameless stereobiopsy groups, resp. In 10 patients, corticosteroid treatment of perifocal brain oedema was conducted continually up until biopsy (including one patient with corticotherapy for pulmonary disease). Lesion regression was observed in 6 of these patients. Transient lesion remission was observed during corticotherapy in one patient with lesion recurrence after steroid discontinuation. In 2 patients, corticosteroids were not administered before biopsy. The results of stereobiopsy were inconclusive in 8 patients (4.9%). Before biopsy, the possibility of brain lymphoma was considered in 3 patients, but the final diagnoses were autoimmune vasculitis, histological changes after embolic events from the thrombosed pulmonary veins in pulmonary malformation and local inflammation.
Although the extent of brain lymphoma decreased after corticosteroid administration, corticotherapy does not exclude valid diagnostic biopsy.Key words: brain lymphoma - stereotaxic techniques - frameless stereotaxy - stereotactic biopsy - corticosreroids Part of the message was presented on XLI. Brno Oncological Days within the Glio Meeting and published in the form of a short abstract. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 27. 5. 2017Accepted: 2. 7. 2017.
背景:由于未经治疗的脑淋巴瘤预后不佳,因此对于患有这种疾病的患者,使用立体定向活检进行早期组织学验证至关重要。本研究分析了在脑淋巴瘤患者中,活检前给予皮质类固醇对立体定向活检诊断结果的影响。
在一组对疑似脑肿瘤患者进行的162例立体定向活检(108例基于框架和54例无框架)中确定脑淋巴瘤患者。对非确诊的活检进行重新评估,以排除漏诊淋巴瘤的可能性。
在基于框架和无框架立体定向活检组中,分别有9例患者(8.3%)和4例患者(7.4%)患有淋巴瘤。10例患者在活检前持续进行了皮质类固醇治疗以减轻灶周脑水肿(包括1例因肺部疾病接受皮质激素治疗的患者)。其中6例患者观察到病变消退。1例患者在皮质类固醇治疗期间病变缓解,停用类固醇后病变复发。2例患者在活检前未使用皮质类固醇。8例患者(4.9%)的立体定向活检结果不确定。活检前,3例患者被考虑患有脑淋巴瘤,但最终诊断为自身免疫性血管炎、肺畸形中来自血栓形成的肺静脉的栓塞事件后的组织学改变以及局部炎症。
尽管给予皮质类固醇后脑淋巴瘤范围缩小,但皮质激素治疗并不排除进行有效的诊断性活检。关键词:脑淋巴瘤 - 立体定向技术 - 无框架立体定向 - 立体定向活检 - 皮质类固醇部分信息在第41届布尔诺肿瘤日的胶质瘤会议上展示,并以简短摘要的形式发表。作者声明他们在研究中使用的药物、产品或服务方面没有潜在的利益冲突。编辑委员会声明该手稿符合ICMJE对生物医学论文的建议。提交日期:2017年5月27日;接受日期:2017年7月2日。