A comparison between ventricular and lumbar cerebrospinal fluid cytology in adult patients with leptomeningeal metastases

Abstract

Leptomeningeal metastases (LMs) are common metastatic complications, occurring in at least 5% of patients with disseminated cancer. Cerebrospinal uid (CSF) cytology remains the standard for diagnosis and assessment of treatment response, but may be inadequate. Our objective was to compare ventricular and lumbar CSF cytology in patients who had cytologically proven LM and were receiving intra-CSF chemotherapy. Sixty patients with LM, positive lumbar CSF cytology documented at diagnosis, limited extent of CNS disease, and no evidence of CSF ow obstruction were treated with a variety of intra-CSF chemotherapies. All patients underwent a single simultaneous ventricular and lumbar CSF sampling (mean volume of CSF per site examined, 10 ml) to assess response to therapy at either 1 or 2 months after treatment initiation. Ventricular CSF cytology was positive in 44 patients (73%), 35 of whom were also positive by lumbar CSF cytology. Lumbar CSF cytology was positive in 45 patients (75%), of which 35 were also positive by ventricular CSF cytology. Samples were negative at both ventricular and lumbar sites in 6 patients (10%). Paired CSF cytologies were discordant in 19 (32%) patients. The lumbar cytology was negative in 9, whereas the ventricular cytology was positive (lumbar false-negative rate of 17%); the ventricular cytology was negative in 10, whereas the lumbar cytology was positive (ventricular false-negative rate of 20%). In the presence of spinal signs or symptoms of LM, the lumbar CSF cytology was more likely to be positive than was the ventricular (odds ratio = 2.86; 95% con dence interval, 0.86-9.56). Conversely, in the presence of cranial signs or symptoms, the ventricular CSF cytology was more likely to be positive than was the lumbar (odds ratio = 2.71; 95% con dence interval, 0.76-9.71). In this cohort of patients, whose LM was documented initially by positive lumbar CSF cytology, ventricular and lumbar CSF samples obtained during treatment had similar false-negative rates, depending on the site of clinical or radiologic disease. This suggests that both lumbar and ventricular sites must be sampled when assessing treatment response. If clinical or radiographic disease is present only at 1 site, then CSF from that site is more likely to be positive than is CSF obtained from the more distant site. Neuro-Oncology 3, 42-45, 2001 (Posted to Neuro-Oncology [serial online], Doc. 00-033, October 19, 2000

Detection of tumor-derived DNA in cerebrospinal fluid of patients with primary tumors of the brain and spinal cord

“…The most important technical limitation of our study is that CSF samples were obtained at the time of surgery, and they were often from the ventricles rather than from a lumbar puncture. CSF has been shown to quickly circulate throughout the ventricles and spinal reservoirs (39,40). It is, therefore, very likely that the DNA in the spinal fluid obtained through lumbar puncture will be similar to that of the ventricles, although the fluid obtained from lumbar puncture is farther away from the site of malignancy.…”

Neoplastic Meningitis

“…In a series of 60 patients with NM, positive lumbar CSF cytology at diagnosis, and no evidence of CSF flow obstruction, ventricular and lumbar cytologies obtained simultaneously were discordant in 30% of cases [24]. The authors observed that, in the presence of spinal signs or symptoms, the lumbar CSF was more likely to be positive and, conversely, in the presence of cranial signs or symptoms, the ventricular CSF was more likely to be positive.…”

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

“…Cytology of the CSF obtained by lumbar puncture is more likely to be positive than CSF obtained using a ventricular catheter if spinal cord-related symptoms are present and vice versa if cranial-related symptoms are present. 67 Periodic lumbar puncture is recommended in the follow-up of patients with neoplastic meningitis, even in those with ventricular catheters, because cytology results have high rates of false-negative results when using samples taken from ventricular catheters. 32,67 Essential elements of the CSF laboratory evaluation include cell count and differential, cytology, protein, and glucose concentrations ( Table 2).…”

“…67 Periodic lumbar puncture is recommended in the follow-up of patients with neoplastic meningitis, even in those with ventricular catheters, because cytology results have high rates of false-negative results when using samples taken from ventricular catheters. 32,67 Essential elements of the CSF laboratory evaluation include cell count and differential, cytology, protein, and glucose concentrations ( Table 2). In patients who have primary solid tumors, a finding of malignant cells in the CSF is evidence of leptomeningeal metastases.…”

“…45 Several series have demonstrated that, in some cases, serial CSF sampling via lumbar puncture or sampling from alternate sites (eg, cisternal, ventricular) is required to detect malignant cells. 11,67,70,71 LDH concentrations are elevated in cases of stroke, bacterial meningitis, CSF pleocytosis, head injury, primary CNS tumors, and some metastases.…”