Diagnostic Pathways and Procedural Risk in Primary Central Nervous System Lymphoma: A Nationwide Analysis.

Area of Science:

• Neurology
• Oncology
• Diagnostic Medicine

Background:

• Primary central nervous system lymphoma (PCNSL) is an aggressive brain cancer requiring prompt diagnosis.
• Cerebrospinal fluid (CSF) analysis is often used, but neurosurgical biopsy is the standard diagnostic method.
• Limited data exists on PCNSL diagnostic pathways, patient characteristics, and associated complications.

Purpose of the Study:

• To evaluate diagnostic approaches for PCNSL.
• To assess post-procedural complications.
• To identify clinical and socioeconomic factors associated with adverse events in PCNSL diagnosis.

Main Methods:

• Utilized the PearlDiver Mariner claims database (2011-2023) for adult PCNSL patients.
• Identified diagnostic pathways: lumbar puncture (LP)-only, biopsy-only, or both.
• Employed logistic regression to determine predictors of adverse events.

Main Results:

• Analyzed 2,549 PCNSL patients: 76.8% LP-only, 15.6% biopsy-only, 7.6% both.
• LP-only patients were younger, more male, Medicaid-insured, and economically disadvantaged.
• Biopsy-only pathway showed significantly higher rates of procedural, thromboembolic, and medical complications compared to LP-only.

Conclusions:

• Diagnostic modality choice for PCNSL is influenced by patient clinical and socioeconomic factors.
• PCNSL patients undergoing neurosurgical biopsy face higher risks, highlighting the need for advanced CSF diagnostics.