Malignant meningitis: a rational approach to cerebrospinal fluid cytology.

Abstract

The progress of non-neoplastic conditions can be monitored by CSF cell count/ differential, protein and glucose concentrations measured by a biomedical scientist without the necessity of the use of expensive pathologist's time in performing cytology. Suspected infections require proper microbiological investigation of the CSF6 and identification of organisms in a cytological preparation is probably only an aesthetic reward for the pathologist and contributes little, if anything, to the patient's management. Yet clinicians frequently adopt the "blunderbuss" approach to requesting of laboratory tests on CSF without due regard to the propriety of tests in the clinical circumstances, with cytology, cell count, protein, glucose, oligoclonal bands, and microbiology often being requested routinely, and pathologists often feel a moral obligation to carry out the tests requested, even if this has no rational basis.This study sought to clarify criteria by which the pathologist can decide when CSF cytology is likely to contribute to the patient's management, and minimise the number of unnecessary cytological tests, firstly, by defining under what circumstances malignant cells are likely to be found in the CSF and, secondly, by validating these criteria in practice.Methods From 1980 to 1990, cytology was carried out on all CSF specimens received in the Neuropathology Laboratory of the Walton Centre for Neurology and Neurosurgery, Liverpool. During that period 5808 cytological specimens were received. All of the reports were reviewed and, in CSF samples from 132 patients, cells variously described as "malignant", "atypical" or "suspicious" had been described. All of the cytospin preparations from these patients were re-examined and CSF samples from 54 patients contained cells which were regarded as definitely malignant.The clinical details and histological material (where available) relating to these 54 patients were reviewed in order to (1) confirm that the diagnosis of malignancy on the basis of CSF cytology was correct and (2) identify criteria by which the decision whether or not to perform cytology could be made in the laboratory. To assist in the second objective, cell counts and protein concentrations, available for 29 of the patients, were also utilised.Having established, and implemented, the criteria 100 cases from 1992 to 1993 for which complete clinical records were available, and in which cytology had not been carried out on the basis of these criteria, were randomly selected and thoroughly reviewed to establish whether there was any possibility that a case of malignant meningitis had been missed.

Diagnostic spectrum of CSF involvement by malignant cells: three-year experience of tertiary care hospital in CSF cytology

“…This is in concordance with all the larger CSF series published earlier by Mackenzie, Prayson and Fischer, Gupta and Chamberlain which established that the main tumor types diagnosed in CSF are metastases from solid malignancies or Lymphoma and Leukaemia. [6][7][8][9] Lung and breast Adenocarcinoma and Melanoma were found to be the commonest solid tumors in above mentioned series. Leptomeningeal disease from other tumors, such as GIT, bladder, kidney, female genital tract and prostate can occur.…”

“…False positive result in CSF is very uncommon as compare to false negative. 6 False negative rates can be reduced by quick processing of the CSF and the examination of larger volume of CSF. 11,28 Correlation with clinical details and Neuroimaging is a must.…”

Multiple cranial neuropathies: one diagnostic difficulty

“…CSF cytological examination is an essential investigation in the diagnosis of malignant meningitis and has an important role in directing clinical management. The specificity of abnormal CSF cytology is 98%–100% in a patient with a known or suspected malignancy outside of the central nervous system who has a clinical presentation consistent with malignant meningitis and a raised CSF protein and/or white cell count 3 4. In a review paper, Zeller et al concluded that in patients who ultimately had a diagnosis of malignant meningitis, 80% had a raised CSF protein, half had a reduced CSF glucose level (<2/3 serum value) and 43% had an elevated CSF opening pressure 5.…”

Is CSF cytology a useful diagnostic procedure in staging paediatric CNS tumours?

“…[1][2][3][4] Patients with CNS malignancy or a mass lesion contribute many of these samples and will often progress to surgery. There is relatively little evidence, however, that informs the optimal use of CSF cytology in children.…”

“…There is relatively little evidence, however, that informs the optimal use of CSF cytology in children. [1][2][3][4] Patients with CNS malignancy or a mass lesion contribute many of these samples and will often progress to surgery. Some will have known primary malignancy outside the CNS (for example leukaemias ⁄ lymphomas), but many will have primary CNS malignancy.…”