| Purpose: In this study,211 cases of primary central nervous system lymphoma who underwent stereotactic frame biopsy for the first time were retrospectively analyzed to identify the case characteristics of primary central nervous system lymphoma and the possible factors affecting the results of the first stereotactic frame biopsy,In order to achieve the purpose of early diagnosis and early treatment of PCNSL,we should arrange clinical biopsy for the patients who meet the characteristics of this case and avoid the influencing factors in the process of biopsy operation.Methods: In this study,the data of patients with central nervous system lymphoma admitted to the Neurosurgery Ward of the sixth medical center of the PLA General Hospital(former Navy General Hospital)from January 2015 to July 2020 were selected,and the data of primary central nervous system lymphoma by frame stereotactic biopsy were selected,The characteristics of general clinical data were summarized by statistical methods,and the clinical factors that may affect the detection of the first frame biopsy results were analyzed Chi square test / T test / Mann Whitney U test were used for univariate analysis;The variables with significant statistical differences in univariate analysis and clinical known related factors were included in the multivariate binary logistic regression model;Odds ratio(or)was determined by 95% confidence interval(CI);The difference was statistically significant(P < 0.05).Results:1.Among the 211 patients,there were 124 males(58.77%)and 87 females(41.23%).The ratio of male to female was 1.43:1.The most common clinical symptoms were headache and dizziness,accounting for 19.34% of the total,and the most rare clinical symptoms were polydipsia and polyuria,accounting for 0.33% of the total;Most of the patients(72.78%)had headache,dizziness,walking disorder,vision disorder,memory loss,nausea and vomiting,speech disorder and other symptoms;The second was drowsiness,sensory disturbance,consciousness disturbance,reaction disturbance,facial paralysis and other clinical symptoms,accounting for 22.96% of the total number;The most rare clinical symptoms were incontinence,epilepsy,drinking cough,polydipsia and polyuria,accounting for 4.26% of the total number.There were 22 patients with complications after biopsy,accounting for 10.42% of the total number.Among them,14 patients had intracranial micro pneumatosis,which was the most common complication after frame surgery,accounting for 63.6% of the total complications;The complications after biopsy were intracranial hemorrhage,secondary epilepsy,cranial nerve injury and intractable hiccup;Other general results of the subjects: the age of onset was 10-86 years old(average 55.82%)± 28 years old,interquartile range 49-64 years old,median 57 years old.The time from clinical symptoms to treatment was 0.07-60 months(30 days per month),with an average of 3.21 months ± 0 months,the interquartile range was0.67-3.17 months,and the median was 1.13 months.The volume of frame biopsy was0.098 ± 116cm3,intraoperative blood loss was 2.99% ± 87 ml,operation time 107.9 ±55.10min。 The average length of stay was 11.68 ± 36 days.2.Participants: imaging features of primary central nervous system lymphoma: in the imaging diagnosis of primary central nervous system lymphoma,126 cases(59.72%,126 / 211)were suspected of central nervous system lymphoma,accounting for 59.72%of the total number;In the initial diagnosis,154 cases were diagnosed with lymphoma,accounting for 72.99% of the total number,including suspected lymphoma,glioma,demyelination,metastasis,inflammatory disease and ependymoma.A total of 35 cases were misdiagnosed,accounting for 16.59%(16.59%,35 / 211);Only 2 cases could not be diagnosed according to imaging and clinical features;There were 37 cases of primary central nervous system lymphoma whose initial diagnosis failed to give correct reference,accounting for 17.54%(17.54%,37 / 211).3.The distribution characteristics of imaging lesions: the top five lesions were frontal lobe in 75 cases,accounting for 14.45%;There were 64 cases in basal ganglia,accounting for 12.33%;57 cases of temporal lobe,accounting for 10.98%;54 cases(10.40%)were paraventricular;The corpus callosum was found in 49 cases(9.44%),and the top five lesions were common in primary central nervous system lymphoma(57.6%);Among them,20 cases(3.86%)were located in insular lobe,corona radiata,septum pellucidum,hippocampus and hypothalamus;Primary central nervous system lymphoma can also involve the brain stem area,a total of 46 cases,accounting for 8.86%.4.Distribution characteristics of puncture targets: the most common site of puncture targets was frontal lobe,accounting for 24.17% of the total number of puncture targets;The top five biopsy targets were frontal lobe,basal ganglia,dorsal thalamus,parietal lobe and paraventricular area in 153 cases(72.51%);Among them,insular lobe,brain stem,corpus callosum,corpus callosum knee and pons arm were rarely selected as puncture targets,accounting for 3.31% of the total target sites;For example,46 cases of brain stem lesions and only 2 cases of target sites were selected.5.Pathological characteristics of the subjects: 15(7.11%,15 / 211)were negative in the first biopsy,196(92.89%,196 / 211)were positive in the first biopsy,of which 190(96.94%,190 / 196)were diffuse large B-cell lymphoma,accounting for the vast majority of the pathological results of primary central nervous system lymphoma;Other rare pathological types of primary central nervous system lymphoma were: 1 case of B-cell lymphoma(0.51%,1 / 196),1 case of B-cell lymphoblastic lymphoma(0.51%,1 /196),1 case of non Hodgkin’s B-cell lymphoma(0.51%,1 / 196),1 case of non Hodgkin’s T-cell lymphoma(0.51%,1 / 196),1 case of T-cell lymphoma(0.51%,1 /196),1 case of high-grade T-cell lymphoma(0.51%,1 / 196),A total of 6 cases,accounting for 3.06% of the total.6.Univariate analysis results: there was no significant difference in gender,age of onset,duration of disease,depth of target,number of lesions,preoperative dehydration,volume of biopsy tissue and detection results of stereotactic biopsy(P > 0.05);There were significant differences in the features of lesion enhancement,preoperative hormone use and positive results of directional biopsy(P < 0.05).7.Results of multivariate analysis: the enhancement characteristics of lesions were the protective factors for stereotactic biopsy to achieve pathological results,and the positive results of biopsy with each enhancement grade were 2.512 times of the previous grade(or = 2.512,P = 0.004,95% CI = 1.344-4.694);Preoperative hormone use was a risk factor for the pathological results of stereotactic biopsy(or = 0.096,P = 0.000,95%CI = 0.027-0.340);There was no significant difference in the clinical suspected factors(specimen size,preoperative dehydration or not),which could not be included in the multivariate regression equation.Conclusion:1.Primary central nervous system lymphoma is more common in men than in women;2.Primary central nervous system lymphoma is mainly characterized by headache,dizziness,focal brain dysfunction,disturbance of consciousness and memory change;3.Primary central nervous system lymphoma usually invades frontal lobe,basal ganglia,temporal lobe,paraventricular and corpus callosum;4.In the simple imaging diagnosis of primary central nervous system lymphoma,the proportion of initial diagnosis consistent with reality is low,and the proportion of false initial diagnosis is high;5.The target selection of simple biopsy is basically consistent with the distribution of lesions.The main biopsy sites are frontal lobe,basal ganglia,dorsal thalamus,parietal lobe and paraventricular area;5.Diffuse large B-cell lymphoma was the main type of pathological findings,and other types of central nervous system lymphoma were rare;7.The characteristics of lesion enhancement and the use of hormone before frame biopsy are the related factors for the detection of pathological positive results;8.The size of the biopsy specimen and the depth of the puncture target have nothing to do with the positive pathological results of frame biopsy.This conclusion is contrary to some literature reports that the volume of the lesion and the depth of the puncture target are the relevant factors affecting the detection of the puncture results,which still needs further study. |
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