• World Neurosurg · Apr 2023

    What is the best preoperative quantitative indicator to differentiate primary central nervous system lymphoma from glioblastoma?

    • Akihiro Inoue, Shirabe Matsumoto, Takanori Ohnishi, Yukihiro Miyazaki, Shingo Kinnami, Kazuhisa Kanno, Takatsugu Honda, Mie Kurata, Mashio Taniwaki, Kosuke Kusakabe, Satoshi Suehiro, Daisuke Yamashita, Seiji Shigekawa, Hideaki Watanabe, Riko Kitazawa, and Takeharu Kunieda.
    • Department of Neurosurgery, Ehime University School of Medicine, Toon, Ehime, Japan. Electronic address: iakihiro3@gmail.com.
    • World Neurosurg. 2023 Apr 1; 172: e517e523e517-e523.

    BackgroundThe role of surgery in primary central nervous system lymphoma (PCNSL) is to allow pathological diagnosis from tumor biopsy. However, PCNSL is often difficult to distinguish from other tumors, particularly glioblastoma multiforme (GBM). Quantitative evaluations to facilitate differentiation between PCNSL and GBM would be useful. Here, we investigated the best examinations for exact differentiation of PCNSL from GBM among preoperative examinations, including imaging studies and tumor markers.MethodsVarious examinations were performed for 68 patients with PCNSL , including serum soluble interleukin 2 receptor, β2-microglobulin (MG) in cerebrospinal fluid (CSF), diffusion-weighted imaging, 11C-methionine-positron emission tomography (PET), and 18F-fluorodeoxyglucose (FDG)-PET. These results were compared with findings from 28 patients with consecutive GBM who underwent the same examinations to evaluate the utility and accuracy of different investigations.ResultsCSF β2-MG ≥2.0 mg/L was relatively specific for PCNSL, offering 95.0% sensitivity and 85.7% specificity. Tumor-to-contralateral normal brain tissue ratio ≥2.4 on 18F-FDG-PET was also quite specific for PCNSL, offering 83.8% sensitivity and 95.2% specificity. No other examinations displayed any significant differences in quantitative differential markers between PCNSL and GBM.ConclusionsBoth β2-MG ≥2.0 mg/dL in CSF and tumor-to-contralateral normal brain tissue ratio ≥2.4 from 18F-FDG-PET allow quantitative differentiation of PCNSL from GBM, potentially representing clinically useful indicators. These findings could lead to innovative methods for differentiating PCNSL from GBM as well as new treatment strategies for other brain tumors.Copyright © 2023 Elsevier Inc. All rights reserved.

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