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. 2015 Nov;17(11):1497-503.
doi: 10.1093/neuonc/nov092. Epub 2015 May 25.

CSF neopterin level as a diagnostic marker in primary central nervous system lymphoma

Aurélien Viaccoz  1 , François Ducray  1 , Yannick Tholance  1 , Gleicy Keli Barcelos  1 , Laure Thomas-Maisonneuve  1 , Hervé Ghesquières  1 , David Meyronet  1 , Isabelle Quadrio  1 , Stéphanie Cartalat-Carel  1 , Guy Louis-Tisserand  1 , Emmanuel Jouanneau  1 , Jacques Guyotat  1 , Jérôme Honnorat  1 , Armand Perret-Liaudet  1
Affiliations

CSF neopterin level as a diagnostic marker in primary central nervous system lymphoma

Aurélien Viaccoz et al. Neuro Oncol. 2015 Nov.

Abstract

Background: The diagnosis of primary central nervous system lymphoma (PCNSL) can be challenging. PCNSL lesions are frequently located deep within the brain, and performing a cerebral biopsy is not always feasible. The aim of this study was to investigate the diagnostic value of CSF neopterin, a marker of neuroinflammation, in immunocompetent patients with suspected PCNSL.

Methods: We retrospectively reviewed the characteristics of 124 patients with brain tumor (n = 82) or an inflammatory CNS disorder (n = 42) in whom CSF neopterin levels were assessed. Twenty-eight patients had PCNSL, 54 patients had another type of brain tumor (glioma n = 36, metastasis n = 13, other n = 5), and 13 patients had a pseudotumoral inflammatory brain lesion.

Results: CSF neopterin levels were significantly higher in the patients with PCNSL than in those with other brain tumors (41.8 vs 5.1 nmol/L, P < .001), those with pseudotumoral inflammatory brain lesions (41.8 vs 4.3 nmol/L, P < .001), and those with nontumefactive inflammatory CNS disorders (41.8 vs 3.8 nmol/L, P < .001). In the 95 patients with space-occupying brain lesions, at a cutoff of 10 nmol/L, the sensitivity of this approach was 96% and the specificity was 93% for the diagnosis of PCNSL. The positive and negative predictive values were 84% and 98%, respectively.

Conclusion: Assessing CSF neopterin levels in patients with a suspected brain tumor might be helpful for the positive and differential diagnosis of PCNSL. A prospective study is warranted to confirm these results.

Keywords: biomarker; cerebrospinal fluid; neopterin; primary central nervous system lymphoma; space-occupying brain lesion.

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Figures

Fig. 1.
Fig. 1.
Box plot representation of CSF neopterin levels in PCNSL patients versus other subgroups. Difference between CSF neopterin levels in PCNSL versus different subgroups was statistically significant (asterisk bar, P < 0.001). No significant difference was observed within subgroups. PCNSL: primary central nervous system lymphoma. GBM: glioblastoma, GLIOMA: other gliomas, OTHER: other brain tumors, PSEUDO-TUM: pseudotumoral inflammatory lesions, CONT: nontumefactive inflammatory CNS disorders. Black dots indicate outliers.
Fig. 2.
Fig. 2.
CSF neopterin level values receiver-operator characteristic (ROC) curve in patients with space occupying brain lesions. Area under the curve is 0.982 (confidence interval: 0.961–1). For a cut-off value of 10 nmol/L, the sensitivity was 96% and the specificity 93%.
Fig. 3.
Fig. 3.
MRI scans from 3 patients with biopsy-proven final diagnosis and corresponding CSF neopterin levels with cut-off value at 10 nmol/L. A and B: glioblastoma with atypical MRI, suggestive of PCNSL and with low CSF neopterin level. C: deep located PCNSL and high CSF neopterin level. D: PCNSL with atypical MRI and high CSF neopterin level.
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