The effects of prebiopsy corticosteroid treatment on the diagnosis of mediastinal lymphoma

Steven H. Borenstein, Ted Gerstle, David Malkin, Paul Thorner, Robert M. Filler

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background/Purpose: For children with probable mediastinal lymphoma and a high risk of cardiorespiratory morbidity, many centers recommend delaying the diagnostic biopsy for 24 to 48 hours while corticosteroids are administered to reduce tumor size and morbidity. This study was undertaken to determine the effect of preoperative steroid use on the accuracy of the pathological diagnosis and incidence of perioperative cardiorespiratory morbidity. Methods: From 1988 to 1998, 86 children were treated for mediastinal lymphoma. Twenty-three received steroid before biopsy (study group) because of clinical evidence of respiratory compromise, and the remaining 63 served as controls. Clinical parameters, steroid use, and detailed pathological findings obtained at initial and subsequent biopsies were reviewed. Steroid treatment was considered to have had an adverse effect on the pathological diagnosis if (1) a definitive diagnosis was delayed more that 1 month, (2) a definitive diagnosis could not be made, or (3) the extent of disease could not be staged with certainty. Results: Steroid treatment had an adverse effect on the pathological diagnosis in 5 of 23 (22%) children: 1 diagnostic delay, 3 failures of a definitive diagnosis, and 1 possible failure of staging. A definitive diagnosis was made in all control patients. Perioperative survival was 100% in both groups. At biopsy, only 3 children in the steroid treatment group and 2 children in the control group had moderate, nonfatal cardiorespiratory instability. Parameters of steroid use among children who had inaccurate pathological diagnoses or cardiorespiratory morbidity were not significantly different from those who did not. Conclusions: Steroid treatment before biopsy of mediastinal lymphoma may adversely affect the pathological accuracy or cause a delay in definitive diagnosis in a minority of cases. The dose and duration of steroid use was not related to outcome. Prebiopsy steroid appears to minimize the likelihood of cardiorespiratory morbidity in high-risk patients. Copyright (C) 2000 by W.B. Saunders Company.

Original languageEnglish (US)
Pages (from-to)973-976
Number of pages4
JournalJournal of Pediatric Surgery
Volume35
Issue number6
StatePublished - Jun 2000
Externally publishedYes

Fingerprint

Lymphoma
Adrenal Cortex Hormones
Steroids
Morbidity
Biopsy
Therapeutics
Delayed Diagnosis
Control Groups
Survival
Incidence

Keywords

  • Airway obstruction
  • Corticosteroid
  • Lymphoma
  • Mediastinum

ASJC Scopus subject areas

  • Surgery

Cite this

The effects of prebiopsy corticosteroid treatment on the diagnosis of mediastinal lymphoma. / Borenstein, Steven H.; Gerstle, Ted; Malkin, David; Thorner, Paul; Filler, Robert M.

In: Journal of Pediatric Surgery, Vol. 35, No. 6, 06.2000, p. 973-976.

Research output: Contribution to journalArticle

Borenstein, SH, Gerstle, T, Malkin, D, Thorner, P & Filler, RM 2000, 'The effects of prebiopsy corticosteroid treatment on the diagnosis of mediastinal lymphoma', Journal of Pediatric Surgery, vol. 35, no. 6, pp. 973-976.
Borenstein, Steven H. ; Gerstle, Ted ; Malkin, David ; Thorner, Paul ; Filler, Robert M. / The effects of prebiopsy corticosteroid treatment on the diagnosis of mediastinal lymphoma. In: Journal of Pediatric Surgery. 2000 ; Vol. 35, No. 6. pp. 973-976.
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AB - Background/Purpose: For children with probable mediastinal lymphoma and a high risk of cardiorespiratory morbidity, many centers recommend delaying the diagnostic biopsy for 24 to 48 hours while corticosteroids are administered to reduce tumor size and morbidity. This study was undertaken to determine the effect of preoperative steroid use on the accuracy of the pathological diagnosis and incidence of perioperative cardiorespiratory morbidity. Methods: From 1988 to 1998, 86 children were treated for mediastinal lymphoma. Twenty-three received steroid before biopsy (study group) because of clinical evidence of respiratory compromise, and the remaining 63 served as controls. Clinical parameters, steroid use, and detailed pathological findings obtained at initial and subsequent biopsies were reviewed. Steroid treatment was considered to have had an adverse effect on the pathological diagnosis if (1) a definitive diagnosis was delayed more that 1 month, (2) a definitive diagnosis could not be made, or (3) the extent of disease could not be staged with certainty. Results: Steroid treatment had an adverse effect on the pathological diagnosis in 5 of 23 (22%) children: 1 diagnostic delay, 3 failures of a definitive diagnosis, and 1 possible failure of staging. A definitive diagnosis was made in all control patients. Perioperative survival was 100% in both groups. At biopsy, only 3 children in the steroid treatment group and 2 children in the control group had moderate, nonfatal cardiorespiratory instability. Parameters of steroid use among children who had inaccurate pathological diagnoses or cardiorespiratory morbidity were not significantly different from those who did not. Conclusions: Steroid treatment before biopsy of mediastinal lymphoma may adversely affect the pathological accuracy or cause a delay in definitive diagnosis in a minority of cases. The dose and duration of steroid use was not related to outcome. Prebiopsy steroid appears to minimize the likelihood of cardiorespiratory morbidity in high-risk patients. Copyright (C) 2000 by W.B. Saunders Company.

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