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.

1st Department of Medicine Hematology University General Hospital Prague and 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Anesthesiology Resuscitaion and Intensive Care Medicine 1st Faculty of Medicine Charles University and Military University Hospital Prague Czech Republic

Department of Methodology Faculty of Physical Education and Sport Charles University Prague Czech Republic

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University and Military University Hospital Prague Czech Republic

Department of Pathology Military University Hospital Prague Czech Republic

Department of Radiodiagnostic Military University Hospital Prague Czech Republic

Faculty of Medicine and Health Sciences McGill University Montreal Canada

Institute of Biophysics and Informatics 1st Faculty of Medicine Charles University Prague Czech Republic

Institute of Pathological Physiology 1st Faculty of Medicine Charles University Prague Czech Republic

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