Surgical results in patients with CNS lymphoma. Comparison of predictive value of intraoperative MRI and intraoperative histological examination for diagnostic biopsy yield

M Majovsky; T Moravec; M Komarc; J Soukup; V Sedlak; N Balasubramaniam; J Brixi; P Klener; M Klanova; D Netuka

doi:10.1016/j.bas.2024.103926

Surgical results in patients with CNS lymphoma. Comparison of predictive value of intraoperative MRI and intraoperative histological examination for diagnostic biopsy yield

Brain Spine. 2024 Oct 18:4:103926. doi: 10.1016/j.bas.2024.103926. eCollection 2024.

Authors

M Majovsky¹, T Moravec¹, M Komarc^{2

3}, J Soukup⁴, V Sedlak⁵, N Balasubramaniam⁶, J Brixi⁷, P Klener^{8

9}, M Klanova^{8

9}, D Netuka¹

Affiliations

¹ Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
² Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic.
³ Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic.
⁴ Department of Pathology, Military University Hospital, Prague, Czech Republic.
⁵ Department of Radiodiagnostic, Military University Hospital, Prague, Czech Republic.
⁶ Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
⁷ Department of Anesthesiology, Resuscitaion and Intensive Care Medicine, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
⁸ Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
⁹ First Department of Medicine - Hematology, University General Hospital Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic.

Abstract

Introduction: Central nervous system lymphoma poses significant diagnostic challenges, with stereotactic biopsy being the gold standard for diagnosis. Intraoperative magnetic resonance imaging and intraoperative histological examination are utilized to enhance biopsy yield, yet their comparative efficacy remains unclear.

Research question: This study aims to compare the diagnostic yield of intraoperative magnetic resonance imaging and intraoperative histological examination in stereotactic brain biopsies for central nervous system lymphoma.

Materials and methods: A retrospective analysis was conducted on 115 patients who underwent stereotactic brain biopsies for central nervous system lymphoma. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative magnetic resonance imaging and intraoperative histological examination were assessed and compared.

Results: Out of 125 surgeries, frameless biopsies were the most common, accounting for 74.4 percent. Intraoperative magnetic resonance imaging demonstrated a sensitivity of 80.00 percent and a specificity of 98.51 percent (AUC = 0.893, p = 0.004), whereas intraoperative histological examination showed a sensitivity of 66.67 percent and a specificity of 59.09 percent (AUC = 0.629, p = 0.459).

Discussion and conclusions: The study emphasizes the critical role of intraoperative examinations, thus improving precision and diagnostic yield in the surgical management of central nervous system lymphoma. Intraoperative magnetic resonance imaging outperforms intraoperative histological examination in terms of sensitivity and specificity for confirming positive biopsy yields in central nervous system lymphoma, thereby reducing the need for additional surgeries. These findings support the routine use of intraoperative magnetic resonance imaging in the surgical strategy for central nervous system lymphoma to improve diagnostic accuracy and patient outcomes.

Keywords: Central nervous system lymphoma; Diagnostic accuracy; Intraoperative MRI; Intraoperative histological examination; Neurooncology; Stereotactic biopsy.