In patients with primary central nervous system lymphoma (PCNSL), the choice of surgical strategy for histopathologic assessments is still controversial, particularly in terms of preoperative corticosteroid (CS) therapy. To provide further evidence for clinical decision-making, we retrospectively analyzed data from 148 consecutive patients who underwent surgery at our institution. Although patients treated with corticosteroids preoperatively were significantly more likely to require a second or third biopsy (p= 0.049), it was only necessary in less than 10% of the cases with preoperative (but discontinued) corticosteroid treatment. Surprisingly, diagnostic accuracy was significantly lower when patients were treated with anticoagulation or dual antiplatelet therapy (p= 0.015). Preoperative CSF sampling did not provide additional information but was associated with delayed surgery (p= 0.02). In conclusion, preoperative CS therapy can challenge the histological diagnosis of PCNSL. At the same time, our data suggest that preoperative CS treatment only presents a relative contraindication for early surgical intervention. If a definitive diagnosis cannot be made after the first surgical intervention, the timing of a repeat biopsy after the discontinuation of CS remains a case-by-case decision. The effect of anticoagulation and dual antiplatelet therapy on diagnostic accuracy might have been underestimated and should be examined closely in future investigations.
对于原发性中枢神经系统淋巴瘤（PCNSL）患者，组织病理学评估的手术策略选择仍存在争议，尤其是在术前皮质类固醇（CS）治疗方面。为临床决策提供进一步证据，我们回顾性分析了本院连续收治的148例手术患者数据。尽管术前接受皮质类固醇治疗的患者需进行二次或三次活检的概率显著更高（p=0.049），但在术前接受（但已停用）皮质类固醇治疗的患者中，仅不足10%的病例需要重复活检。值得注意的是，接受抗凝或双重抗血小板治疗的患者诊断准确率显著降低（p=0.015）。术前脑脊液取样未能提供额外诊断信息，且与手术延迟相关（p=0.02）。综上，术前CS治疗可能增加PCNSL组织学诊断的难度，但我们的数据同时表明，术前CS治疗仅构成早期手术干预的相对禁忌证。若首次手术干预后未能获得明确诊断，CS停药后重复活检的时机仍需个体化决策。抗凝及双重抗血小板治疗对诊断准确率的影响可能被低估，值得未来研究重点关注。
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