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. 2022 Jun 1;11(2):CNS83.
doi: 10.2217/cns-2022-0004. Epub 2022 Apr 4.

Systemic inflammatory biomarkers in primary central nervous system lymphoma versus high-grade glioma: exploratory, comparative and correlative analysis

Tejpal Gupta  1 , Prashant Nayak  1 , Yamini Baviskar  1 , Meetakshi Gupta  1 , Aliasgar Moiyadi  2 , Sridhar Epari  3 , Amit Janu  4 , Nilendu Purandare  5 , Venkatesh Rangarajan  5 , Bhausaheb Bagal  6 , Abhishek Chatterjee  1 , Goda Jayant Sastri  1
Affiliations

Systemic inflammatory biomarkers in primary central nervous system lymphoma versus high-grade glioma: exploratory, comparative and correlative analysis

Tejpal Gupta et al. CNS Oncol. .

Abstract

Aim: To assess systemic inflammatory biomarkers in non invasive differential diagnosis of primary central nervous system lymphoma (PCNSL) from high-grade glioma (HGG). Materials & methods: Patients with similar morphology (PCNSL or HGG) on conventional neuro-imaging were included. Systemic inflammatory indices were calculated from pretreatment complete blood counts and liver function tests and compared against histopathology as reference standard. Results: Mean values of absolute lymphocyte count and prognostic nutritional index were significantly different between PCNSL (n = 42) versus HGG (n = 16). Area under receiver operating characteristics curve for absolute lymphocyte count and prognostic nutritional index in the diagnosis of PCNSL was 0.70 and 0.72 respectively suggesting fair and acceptable diagnostic accuracy. Conclusion: Systemic inflammatory biomarkers complement established clinico-radiological features and aid in the differential diagnosis of PCNSL from HGG.

Keywords: PCNSL; diagnosis; high-grade glioma; imaging; inflammation.

Plain language summary

There exists a complex interplay between cancer and inflammation that can manifest as increased inflammatory biomarkers in blood. However, utility of systemic inflammatory biomarkers in the non invasive differential diagnosis of primary brain lymphoma from high-grade glioma is generally lacking. Two simple serum biomarkers, absolute lymphocyte count and prognostic nutritional index, easily derived from routine pretreatment blood tests have fair correlation and acceptable diagnostic accuracy in differentiating brain lymphoma from glioma in patients with similar morphology on MRI.

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Conflict of interest statement

Financial & competing interests disclosure

This correlative analysis did not receive any separate funding. All the FDG-PET/CT scans on the index imaging study were funded through a competitive intramural research grant (TMC IEC Project no. 145) secured by the Principal Investigator-cum-corresponding author. However, the sponsor had no role in the study design, conduct, data collection, analysis or reporting of results. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.
Figure 1.. Flow-diagram showing flow of participants in the study.
CBC: Complete blood count; HGG: High-grade glioma; LFT: Liver function test; PCNSL: Primary central nervous system lymphoma; ROC: Receiver operating characteristics.
Figure 2.
Figure 2.. Boxplots (median with interquartile range) comparing absolute lymphocyte count in patients with biopsy-proven primary central nervous system lymphoma versus high-grade glioma.
Note the significantly lower levels of ALC in PCNSL compared with HGG. ALC: Absolute lymphocyte count; HGG: High-grade glioma; PCNSL: Primary central nervous system lymphoma.
Figure 3.
Figure 3.. Boxplots (median with interquartile range) comparing prognostic nutritional index in patients with biopsy-proven primary central nervous system lymphoma versus high-grade glioma.
Note the significantly lower value of PNI in PCNSL compared with HGG. HGG: High-grade glioma; PCNSL: Primary central nervous system lymphoma; PNI: Prognostic nutritional index.
Figure 4.
Figure 4.. Receiver operating characteristics curves of absolute lymphocyte count and prognostic nutritional index in the differentiation of primary central nervous system lymphoma from high-grade glioma.
Note that the upper left corner of the respective curves provides the most optimal cut-off value of ALC and PNI respectively in the noninvasive diagnosis of primary central nervous system lymphoma. ALC: Absolute lymphocyte count; PNI: Prognostic nutritional index.
See this image and copyright information in PMC

References

    1. Rubenstein J, Ferreri AJM, Pittaluga S. Primary lymphoma of the central nervous system: epidemiology, pathology and current approaches to diagnosis, prognosis and treatment. Leuk. Lymphoma 49(Suppl. 1), 43–51 (2008). - PMC - PubMed
    1. Schaff LR, Grommes C. Primary central nervous system lymphoma. Blood (2021) (Epub ahead of print). - PMC - PubMed
    1. Tang YZ, Booth TC, Bhogal P, Malhotra A, Wilhelm T. Imaging of primary central nervous system lymphoma. Clin. Radiol. 66, 768–777 (2011). - PubMed

    2. •• Describes and discusses imaging characteristics of primary central nervous system lymphoma (PCNSL).

    1. Malikova H, Koubska E, Weichet J et al. Can morphological MRI differentiate between primary central nervous system lymphoma and glioblastoma? Cancer Imaging 16, 40 (2016). - PMC - PubMed
    1. Gupta M, Gupta T, Purandare N et al. Utility of flouro-deoxy-glucose positron emission tomography/computed tomography in the diagnostic and staging evaluation of patients with primary CNS lymphoma. CNS Oncol. 8(4), CNS46 (2019). - PMC - PubMed

    2. • Systematically assesses the role of pretreatment FDG-PET/CT in the diagnosis and staging of suspected PCNSL.

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