“Tissue biopsy remains essential for the histopathologic and immunophenotypic evaluation of DLBCL, as treatment decisions hinge on diagnostic accuracy. Steroids induce cytolysis of malignant B cells, resulting in apoptosis and tumor necrosis, and are therefore hypothesized to compromise diagnostic yield. Steroid-induced B-cell lysis can lead to increased infiltration by reactive macrophages and lymphocytes, potentially obscuring diagnostic features.8-10 In addition, steroids may alter cluster of differentiation (CD20) immunoreactivity—a key diagnostic marker—leading to patchy or atypical staining patterns. Radiologically, this effect has been observed as rapid tumor involution on imaging, earning the descriptor ghost tumor. Nonetheless, more recent evidence suggests that a steroid administration before baseline positron emission tomography or computed tomography does not diminish diagnostic yield in DLBC.”

“The limited body of evidence addressing prebiopsy steroid use in lymphoma largely centers on PCNSL and yields mixed conclusions. Earlier retrospective studies focusing on pediatric mediastinallymphoma and PCNSL respectively, reported reduced diagnostic rates in steroid-treated groups. While one of these studies found no correlation between steroid dose or duration and diagnostic accuracy, another noted that steroid use beyond one week before biopsy was associated with reduced diagnostic yield. More recent retrospective studies, however, align more closely with our findings, demonstrating no difference in diagnostic accuracy between steroid-treated and untreated patients in PCNSL cohorts. One of these studies also found no association between steroid dose or duration and biopsy yield. A multicenter retrospective study reported that while steroid use was associated with an increased need for repeat biopsies, it did not significantly impact the overall diagnostic delay.”

Madireddy, Sathwik et al. “Prebiopsy Steroids and Diagnostic Yield in Patients With Diffuse Large B-Cell Lymphoma.” JAMA network open vol. 8,12 e2548617. 1 Dec. 2025 Free Full Text