Inoue Akihiro, Matsumoto Shirabe, Ohnishi Takanori, Miyazaki Yukihiro, Kinnami Shingo, Kanno Kazuhisa, Honda Takatsugu, Kurata Mie, Taniwaki Mashio, Kusakabe Kosuke, Suehiro Satoshi, Yamashita Daisuke, Shigekawa Seiji, Watanabe Hideaki, Kitazawa Riko, Kunieda Takeharu
Department of Neurosurgery, Ehime University School of Medicine, Toon, Ehime, Japan.
Department of Neurosurgery, Ehime University School of Medicine, Toon, Ehime, Japan.
World Neurosurg. 2023 Apr;172:e517-e523. doi: 10.1016/j.wneu.2023.01.065. Epub 2023 Jan 21.
The role of surgery in primary central nervous system lymphoma (PCNSL) is to allow pathological diagnosis from tumor biopsy. However, PCNSL is often difficult to distinguish from other tumors, particularly glioblastoma multiforme (GBM). Quantitative evaluations to facilitate differentiation between PCNSL and GBM would be useful. Here, we investigated the best examinations for exact differentiation of PCNSL from GBM among preoperative examinations, including imaging studies and tumor markers.
Various examinations were performed for 68 patients with PCNSL , including serum soluble interleukin 2 receptor, β2-microglobulin (MG) in cerebrospinal fluid (CSF), diffusion-weighted imaging, C-methionine-positron emission tomography (PET), and F-fluorodeoxyglucose (FDG)-PET. These results were compared with findings from 28 patients with consecutive GBM who underwent the same examinations to evaluate the utility and accuracy of different investigations.
CSF β2-MG ≥2.0 mg/L was relatively specific for PCNSL, offering 95.0% sensitivity and 85.7% specificity. Tumor-to-contralateral normal brain tissue ratio ≥2.4 on F-FDG-PET was also quite specific for PCNSL, offering 83.8% sensitivity and 95.2% specificity. No other examinations displayed any significant differences in quantitative differential markers between PCNSL and GBM.
Both β2-MG ≥2.0 mg/dL in CSF and tumor-to-contralateral normal brain tissue ratio ≥2.4 from F-FDG-PET allow quantitative differentiation of PCNSL from GBM, potentially representing clinically useful indicators. These findings could lead to innovative methods for differentiating PCNSL from GBM as well as new treatment strategies for other brain tumors.
手术在原发性中枢神经系统淋巴瘤（PCNSL）中的作用是通过肿瘤活检进行病理诊断。然而，PCNSL常常难以与其他肿瘤区分开来，尤其是多形性胶质母细胞瘤（GBM）。有助于区分PCNSL和GBM的定量评估将很有用。在此，我们在术前检查（包括影像学研究和肿瘤标志物）中，研究了能准确区分PCNSL和GBM的最佳检查方法。
对68例PCNSL患者进行了各种检查，包括血清可溶性白细胞介素2受体、脑脊液（CSF）中的β2-微球蛋白（MG）、弥散加权成像、C-蛋氨酸正电子发射断层扫描（PET）和F-氟脱氧葡萄糖（FDG）-PET。将这些结果与28例连续接受相同检查的GBM患者的检查结果进行比较，以评估不同检查的实用性和准确性。
脑脊液β2-MG≥2.0 mg/L对PCNSL具有相对特异性，敏感性为95.0%，特异性为85.7%。F-FDG-PET上肿瘤与对侧正常脑组织比值≥2.4对PCNSL也具有较高特异性，敏感性为83.8%，特异性为95.2%。没有其他检查显示PCNSL和GBM在定量鉴别标志物方面有任何显著差异。
脑脊液中β2-MG≥2.0 mg/dL以及F-FDG-PET上肿瘤与对侧正常脑组织比值≥2.4均可对PCNSL和GBM进行定量鉴别，可能代表临床上有用的指标。这些发现可能会带来区分PCNSL和GBM的创新方法以及其他脑肿瘤的新治疗策略。
