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Purpose: For children with probable mediastinal lymphoma and high risk of cardiorespiratory morbidity, many centers recommend that the diagnostic biopsy be delayed for 24-48 hours while corticosteroids are administered to reduce tumor size and morbidity. This study was undertaken to determine the effect of pre-operative steroid use on the accuracy of the pathologic diagnosis and incidence of peri-operative cardiorespiratory morbidity. Methods: From 1988 to 1998, 86 children were treated for mediastinal lymphoma. 23 received steroid prior to biopsy (study group) and the remaining 63 served as controls. Clinical parameters, steroid use, and detailed pathologic studies obtained at initial and subsequent biopsies were reviewed. Steroid treatment was considered to have an adverse effect on the pathologic diagnosis if (1) definitive diagnosis was delayed more that 1 month, (2) 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 pathologic diagnosis in 5 of 23 (22%; 95% confidence interval, 7-44%) children: 1 diagnostic delay, 3 failures of a definitive diagnoses, and I failure of staging. A definitive diagnosis was made in all control patients. Peri-operative 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, non-fatal cardiorespiratory instability. Parameters of steroid use among children who had inaccurate pathologic diagnoses or cardiorespiratory morbidity were not significantly different from those who did not. Conclusions: Pre-biopsy steroids will adversely affect the pathologic accuracy of the later biopsy in some cases. The dose and duration of steroid use was not related to outcome. The use of steroids decreases the risks of cardiorespiratory morbidity in high risk patients., Steven Borenstein MD(1), Ted Gerstle MD(1), David Malkin MD(2), Paul Thorner MD(3), and Robert Filler MD, FAAP(1); (1)Departments of General Surgery, (2)Hematology/Oncology and (3)Pathology, The Hospital For Sick Children, Toronto, [...]