Comparison of cisternal and lumbar CSF examination in leptomeningeal metastasis

Rogers, Lisa; Duchesneau, Paul M.; Nunez, Carlos; Fishleder, Andrew J.; Weick, James K.; Bauer, L.; Boyett, James M.

doi:10.1212/wnl.42.6.1239

Cited by 79 publications

(37 citation statements)

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“…Of note, a series including lymphomatous and leukemic meningitis by Kaplan et al [3] observed the frequent dissociation between the CSF cell count and malignant cytology (29% of cytologically positive CSF had concurrent CSF counts Ͻ4/mm 3 ). Murray et al [22] and Rogers et al [22,23] showed that CSF levels of protein, glucose, and malignant cells vary at different levels of the neuraxis even if there is no obstruction of the CSF flow. This finding reflects the multifocal nature of neoplastic meningitis and explains why CSF obtained from a site distant to that of the pathologically involved meninges may yield negative cytology.…”

Section: Csf Examinationmentioning

confidence: 99%

Neoplastic Meningitis

2008

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After completing this course, the reader should be able to:1. Describe the epidemiology of leptomeningeal metastasis.2. Participate in the diagnosis of leptomeningeal metastasis. Engage in the treatment of leptomeningeal metastasis.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground: Neoplastic meningitis (NM) is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer.Methods: Notwithstanding frequent focal signs and symptoms, NM is a disease affecting the entire neuraxis, and therefore staging and treatment need encompass all cerebrospinal fluid (CSF) compartments.Results: Central nervous system staging of NM includes contrast-enhanced cranial computerized tomography or magnetic resonance imaging (MR-Gd), contrast-enhanced spine magnetic resonance imaging or computerized tomographic myelography and radionuclide CSF flow study. Treatment of NM incorporates involved-field radiotherapy of bulky or

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Section: Csf Examinationmentioning

confidence: 99%

Neoplastic Meningitis

2008

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“…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.…”

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confidence: 99%

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

Rigakos¹,

Liakou²,

Felipe

et al. 2017

Cancer Control

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“…Particular emphasis should be placed on examining CSF from sites of clinical or neuroradiographic disease, as these are more likely to be cytologically positive. Though not directly studied, the ndings in this study also suggest that the initial clinical or radiographic diagnosis of LM is more likely to be con rmed by CSF sampling directed at the site of clinical or neuroradiographic disease (Glantz et al, 1998;Rogers et al, 1992). These ndings have implications for both the clinical management and the design and interpretation of clinical trials involving patients with LM.…”

Section: Discussionmentioning

confidence: 59%

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

Chamberlain¹,

Kormanik²,

Glantz³

2001

Neuro-Oncol

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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

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Comparison of cisternal and lumbar CSF examination in leptomeningeal metastasis

Cited by 79 publications

References 0 publications

Neoplastic Meningitis

Neoplastic Meningitis

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

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

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