Prebiopsy Steroids and Diagnostic Yield in Patients With Diffuse Large B-Cell Lymphoma

Area of Science:

• Hematology
• Oncology
• Pathology

Background:

• Corticosteroids are commonly used for symptom management in diffuse large B-cell lymphoma (DLBCL).
• Clinical concerns exist regarding potential negative impacts of prebiopsy steroid administration on diagnostic accuracy.
• The association between prebiopsy steroid use and biopsy outcomes in DLBCL is not well-established.

Purpose of the Study:

• To investigate the association between corticosteroid administration prior to biopsy and the diagnostic yield in patients newly diagnosed with DLBCL.

Main Methods:

• Retrospective case series of 320 adult patients with newly diagnosed DLBCL.
• Analysis of institutional hematology and pathology databases (2015-2024).
• Logistic regression used to assess steroid exposure (dose, duration, withdrawal) and diagnostic yield, controlling for biopsy type.

Main Results:

• No significant difference in diagnostic yield between patients receiving prebiopsy corticosteroids (83%) and those who did not (81%).
• Prebiopsy steroid use was not associated with delays in treatment initiation after negative biopsies.
• Biopsy technique was a significant factor; core needle and fine needle aspiration were less likely to be diagnostic than excisional or incisional biopsies.

Conclusions:

• Prebiopsy corticosteroid administration does not appear to reduce diagnostic yield or delay treatment in newly diagnosed DLBCL patients.
• Biopsy technique is the primary determinant of diagnostic success in DLBCL.
• Findings support a pragmatic approach to corticosteroid use during the initial evaluation of DLBCL.