Doctors may not need to avoid steroids before biopsy in patients with a common aggressive lymphoma, according to a new study from a US academic medical center. The research suggests that short-term corticosteroid use does not appear to undermine biopsy accuracy or delay treatment in adults with newly diagnosed diffuse large B-cell lymphoma (DLBCL).
Study overview
Researchers reviewed records of 320 adults diagnosed with DLBCL between 2015 and 2024 at a single tertiary academic system affiliated with Brown University. The team compared biopsy results and treatment timing between patients who did and did not receive corticosteroids in the 30 days before their first tissue biopsy. All patients had newly diagnosed systemic DLBCL; those with relapsed disease or primary central nervous system lymphoma were excluded.
Steroids and diagnostic yield
Overall, 48 patients (15%) received corticosteroids before biopsy, while 272 did not. The initial biopsy was diagnostic in 83% of steroid-exposed patients and 81% of those without prior steroid exposure, a difference that was not statistically significant. Statistical modelling found no meaningful association between diagnostic yield and steroid dose, duration, or the number of days off steroids before biopsy. Among patients whose first biopsy was negative, time from that biopsy to the start of chemotherapy was also similar regardless of steroid exposure.
Role of biopsy technique
While steroids did not appear to affect whether a biopsy confirmed DLBCL, the type of biopsy did. Excisional and incisional biopsies were most likely to provide a diagnosis. In contrast, core needle biopsies were modestly less likely to be diagnostic, and fine needle aspiration had a substantially lower diagnostic yield, underscoring existing recommendations that larger tissue samples are preferable when lymphoma is suspected.
Clinical implications
The findings challenge long-standing caution about giving corticosteroids before biopsy in symptomatic DLBCL. The authors conclude that, in this cohort, prebiopsy steroid use did not reduce diagnostic yield or delay treatment initiation. This supports a more pragmatic approach, allowing clinicians to use steroids to stabilize or relieve symptoms without necessarily compromising diagnostic accuracy.
Reference
Madireddy S et al. Prebiopsy steroids and diagnostic yield in patients with diffuse large B-cell lymphoma. JAMA Netw Open. 2025;8(12):e2548617.
