在怀疑淋巴瘤的立体脑活检之前使用皮质类固醇
Maged T Ghoche1,2, Kenji Miki1,2, Skyler Oken1,2
1Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA.
Neurosurgery
|October 2, 2025
概括
手术前的皮质类固醇治疗 (CST) 并没有显著影响用于初级中枢神经系统淋巴瘤 (PCNSL) 的立体脑活检 (SBB) 的诊断产量. 这支持在疑似PCNSL病例中在SBB之前安全使用CST进行症状管理.
科学领域:
- 神经瘤学神经瘤学
- 瘤病理学的病理学
- 神经外科 神经外科
背景情况:
- 初级中枢神经系统淋巴瘤 (PCNSL) 是一种需要准确诊断的侵袭性恶性瘤.
- 立体脑活检 (SBB) 是PCNSL诊断的黄金标准.
- 手术前的皮质类固醇治疗 (CST) 可能会影响SBB诊断产量,因为潜在的细胞减少.
研究的目的:
- 评估手术前CST对PCNSL中SBB诊断产量的影响.
- 评估CST时间,剂量和持续时间如何影响诊断准确度.
- 确定PCNSL患者在CST上的SBB相关的术后并发症的发生率.
主要方法:
- 对104名病理确诊的PCNSL患者进行了回顾性审查,这些患者接受了SBB.
- 基于手术前CST暴露的患者分类 (是/不是).
- 按CST时间,累积剂量和持续时间分层;分析临床,放射和病理变量.
主要成果:
- 对于SBB的整体诊断收益率为92.3%.
- 诊断收益率很高,在接受CST (95.3%) 和不接受CST (90.2%) 的患者之间没有显著差异.
- CST时间,累积剂量和持续时间没有显著影响诊断产量;手术后并发症在各组之间是相似的.
结论:
- 手术前的CST不会显著地影响SBB对PCNSL的诊断准确性.
- 在SBB之前,CST可以安全地用于疑似PCNSL的症状控制.
- 优化活检时间,技术和跨学科协调对于诊断成功至关重要.
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