Abstract Details

Title The Effect of Corticosteroids on Time to Diagnosis in CNS Lymphoma and Other Inflammatory Brain Lesions

Topic Neuro-oncology

Presentation(s) P07 - (-)

Poster/Presentation
Number 007

Objective

Background BACKGROUND: CNS lymphoma may present with progressive neurological complaints and enhancing lesions on brain imaging. Exposure to CS in patients with primary central nervous system lymphoma has been reported to have cytolytic effects on lymphocytes, and to reduce or eliminate abnormalities on contrast-enhanced neuroimaging.

Design/Methods DESIGN/METHODS: A retrospective review of brain biopsy records from 2005-2011 was conducted at a single institution to identify cases of inflammatory neurological conditions. Primary and metastatic solid tumors were excluded. Clinical characteristics and CS exposure prior to biopsy were collected. A neuroradiologist reviewed preoperative brain MRI scans blinded to CS exposure. A neuropathologist reviewed brain biopsies blinded to the original diagnosis or CS exposure.

Results RESULTS: Clinical Characteristics: A total of 169 cases were identified (68 CNS lymphoma, 54 non-diagnostic, 13 demyelinating, 11 granulomatous). Fifty-one percent had documented exposure to CS. Radiographic features: Imaging was reviewed in detail for 110 cases. Brain lesions were contrast-enhancing in 85%, and solitary in 42%. Seventeen percent were immunosuppressed. Neuropathology: 126 biopsies were divided into 5 categories based on histologic features. Detailed CS information was available in 107. In CNSL, 71% of patients were treated with CS, and treatment effect was suspected by the reviewer in 56%.

Conclusions CONCLUSIONS: There was a high incidence of nondiagnostic biopsy in this cohort (32%). In many instances, preoperative CS administration did not interfere with the diagnosis of CNS lymphoma. CS as well as other factors such as lesion location, sampling, or intrinsic features of the underlying disease may have contributed to a non-diagnostic result in these cases.

Authors/Disclosures
Brian Scott, MD (Stanford University Center for Academic Medicine) PRESENTER	Dr. Scott has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Legend Biotech.
Vanja C. Douglas, MD, FAAN (Univ of California, San Francisco)	Dr. Douglas has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Various legal firms. Dr. Douglas has received publishing royalties from a publication relating to health care. Dr. Douglas has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
S. A. Josephson, MD, FAAN (UCSF)	Dr. Josephson has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Josephson has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for McGraw Hill---Harrison's Principles of Internal Medicine. Dr. Josephson has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various legal firms. The institution of Dr. Josephson has received research support from NINDS. Dr. Josephson has received publishing royalties from a publication relating to health care. Dr. Josephson has received publishing royalties from a publication relating to health care.
Ronald C. Petersen, MD, PhD, FAAN (Mayo Clinic)	Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly and Co.. Dr. Petersen has received personal compensation in the range of $0-$499 for serving as a Consultant for Eisai, Inc.. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novo Nordisk. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has a non-compensated relationship as a Board of Directors with American Brain Foundation that is relevant to AAN interests or activities.

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