MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver , British Columbia , Canada.
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver , British Columbia , Canada.
Neurosurgery. 2024 Oct 1;95(4):740-750. doi: 10.1227/neu.0000000000002944. Epub 2024 Apr 23.
Despite general acceptance that corticosteroid therapy (CST) should be withheld before biopsy for suspected primary central nervous system lymphoma (PCNSL), there remains conflicting evidence surrounding the precise impact of preoperative CST on the histopathological diagnosis. The objective of this systematic review and meta-analysis was to describe and quantify the effects of preoperative CST on the diagnostic accuracy of biopsies for PCNSL.
Primary articles were screened from Ovid MEDLINE, Embase, Web of Science, and Scopus databases. Meta-analysis was performed for immunocompetent patients with histologically confirmed PCNSL. Subgroup and regression analyses were performed to assess the effects of biopsy type, CST duration, dose, and preoperative taper on the diagnostic accuracy. In addition, the sensitivity of cerebrospinal fluid (CSF) analyses for PCNSL was assessed.
Nineteen studies, comprising 1226 patients (45% female; mean age: 60.3 years), were included. Preoperative CST increased the risk of nondiagnostic biopsy with a relative risk (RR) of 2.1 (95% CI: 1.1-4.1). In the stereotactic biopsy subgroup, the RR for nondiagnostic biopsy was 3.0 (95% CI: 1.2-7.5). CST taper, duration, and dose did not significantly influence diagnostic biopsy rates. The sensitivity of CSF cytology, including flow cytometry, for PCNSL was 8.0% (95% CI: 6.0%-10.7%).
Our results suggest that preoperative CST reduces the diagnostic yield of stereotactic biopsies for PCNSL. We found no evidence that tapering CST before biopsy improves diagnostic rates. CSF analysis currently has a poor sensitivity for the diagnosis of PCNSL.
尽管普遍认为皮质类固醇治疗（CST）应该在疑似原发性中枢神经系统淋巴瘤（PCNSL）的活检前停止，但关于术前 CST 对组织病理学诊断的确切影响仍存在矛盾的证据。本系统评价和荟萃分析的目的是描述和量化术前 CST 对 PCNSL 活检诊断准确性的影响。
从 Ovid MEDLINE、Embase、Web of Science 和 Scopus 数据库筛选主要文章。对组织学证实的 PCNSL 免疫功能正常的患者进行荟萃分析。进行亚组和回归分析，以评估活检类型、CST 持续时间、剂量和术前减量对诊断准确性的影响。此外，还评估了脑脊液（CSF）分析对 PCNSL 的敏感性。
纳入了 19 项研究，共 1226 名患者（45%为女性；平均年龄：60.3 岁）。术前 CST 增加了非诊断性活检的风险，相对风险（RR）为 2.1（95%可信区间：1.1-4.1）。在立体定向活检亚组中，非诊断性活检的 RR 为 3.0（95%可信区间：1.2-7.5）。CST 减量、持续时间和剂量对诊断性活检率没有显著影响。CSF 细胞学（包括流式细胞术）对 PCNSL 的敏感性为 8.0%（95%可信区间：6.0%-10.7%）。
我们的结果表明，术前 CST 降低了立体定向活检对 PCNSL 的诊断产量。我们没有发现 CST 在活检前减量可以提高诊断率的证据。CSF 分析目前对 PCNSL 的诊断敏感性较差。
