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5 YEARS EXPERIENCE OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL): A RETROSPECTIVE PILOT AUDIT
  1. Sayan Datta,
  2. Rebecca Lee,
  3. Tom Webb,
  4. Azzam Ismail,
  5. Agam Jung
  1. Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Abstract

Introduction Primary Central Nervous System lymphoma (PCNSL) is responsible for 5% of all primary brain tumours within the UK. Barriers to diagnosis include steroid-responsiveness/false-negative biopsy and poor CSF sensitivity. We performed a pilot audit reflecting 5 years experience of PCNSL diagnosis based on criteria derived from 2011 British Neuro-Oncology guidelines.

Methods Retrospective case note and electronic patient record review for patients between 2008 to 2013 with biopsy-proven label of PCNSL. Imaging and staging results were reviewed to exclude secondary/metastatic disease.

Results 20 patients were identified; median age of 58 and 60% were male. Top three clinical presentations were cognitive, paresis and ataxia. Median duration of symptoms was 21 days (range 3 to 180) and median time to biopsy was 14 days.

Pre-biopsy 5 patients had negative CSF, 20% had steroids with documented clinical reason, 5% had record of HIV status checked and 88% had CT staging.

Conclusion Despite limitations, this audit identified that the majority of these patients received steroids pre-biopsy, but in some cases, this may have reasonably been withheld. There is scope for a diagnostic algorithm to highlight safe withholding of steroids, early HIV testing and appropriate staging investigations, downplaying the importance of CSF sampling.

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