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Review
. 2024 Jun 11;166(1):261.
doi: 10.1007/s00701-024-06138-3.

Diagnostics and treatment delay in primary central nervous system lymphoma: What the neurosurgeon should know

M C Hasner  1 , M P van Opijnen  2 , M van der Meulen  3 , R M Verdijk  4   5 , S L N Maas  4   5 , L C J Te Boome  6 , M L D Broekman  7   2
Affiliations
Review

Diagnostics and treatment delay in primary central nervous system lymphoma: What the neurosurgeon should know

M C Hasner et al. Acta Neurochir (Wien). .

Abstract

Purpose: The gold standard for diagnostics in primary central nervous system lymphoma (PCNSL) is histopathological diagnosis after stereotactic biopsy. Yet, PCNSL has a multidisciplinary diagnostic work up, which associated with diagnostic delay and could result in treatment delay. This article offers recommendations to neurosurgeons involved in clinical decision-making regarding (novel) diagnostics and care for patients with PCNSL with the aim to improve uniformity and timeliness of the diagnostic process for patients with PCNSL.

Methods: We present a mini review to discuss the role of stereotactic biopsy in the context of novel developments in diagnostics for PCNSL, as well as the role for cytoreductive surgery.

Results: Cerebrospinal fluid-based diagnostics are supplementary and cannot replace stereotactic biopsy-based diagnostics.

Conclusion: Histopathological diagnosis after stereotactic biopsy of the brain remains the gold standard for diagnosis. Additional diagnostics should not be a cause of diagnostic delay. There is currently no sufficient evidence supporting cytoreductive surgery in PCNSL, with recent studies showing contradictive data and suboptimal study designs.

Keywords: Cerebrospinal fluid-based diagnostics; Diagnostic delay; Primary central nervous system lymphoma; Stereotactic biopsy.

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Conflict of interest statement

None of the authors declare a conflict of financial or non-financial interest.

Figures

Fig. 1
Fig. 1
Example of magnetic resonance imaging (MRI) of the brain for patient suffering from primary central nervous system lymphoma (PCNSL). a T1-weighted; b T1-weighted post gadolinium; c T2-weighted; d Fluid-attenuated inversion recovery (FLAIR); e Diffusion-weighted imaging (DWI); f Apparent diffusion coefficient (ADC)
Fig. 2
Fig. 2
Example of microscopy images (400 × magnification) of Eppstein Bar virus-positive primary central nervous system lymphoma (PCNSL). a Chromogen situ hybridization (CISH) portraying a blue positive EBER stain in; b Immunohistochemical staining of B-cell nuclei with Pax 5; c Immunohistochemical staining of membrane and cytoplasm of B-cells with CD79a; d Histological staining with hematoxylin and eosin
See this image and copyright information in PMC

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