Abstract
To determine the diagnostic utility of serial cerebrospinal fluid (CSF) examinations for hematological malignancy causing neurological disease. All CSF cytology reports at Mayo Clinic Rochester from 2005 to 2014 (n = 20,018) were reviewed. Study inclusion criteria were: repeated CSF examinations within 1 year in patients without known hematological malignancy performed to determine if hematological malignancy was the cause of neurological disease. Exclusion criteria were: preexisting hematological malignancy; >1 year between CSF examinations, serial CSF examinations for infection, tumor surveillance or intrathecal therapies, and for assessment or treatment of CSF dynamics (e.g. idiopathic intracranial hypertension, CSF shunt or persistent CSF leak). The initial study population included patients undergoing three or more serial CSF examinations; subsequently those undergoing two serial CSF examinations were investigated. A total of 613 patients met the study criteria with 477 having two CSF examinations and 136 having three or greater CSF examinations. Of those with three or greater serial CSF examinations none were found to have hematological malignancy exclusively on the third or subsequent CSF examinations. Of those with two CSF examinations 0.4 % (2/477) were found to have hematological malignancy (large B cell lymphomas) exclusively on the second CSF. Ten patients (1.6 %) had suspicious hematological abnormalities on initial CSF examinations confirmed on subsequent CSF examinations. Serial CSF examinations are of low yield to diagnose hematological malignancy as a cause of neurological disease but may confirm atypical features observed in an initial CSF examination.
Similar content being viewed by others
References
Henry JM, Heffner RR Jr, Dillard SH, Earle KM, Davis RL (1974) Primary malignant lymphomas of the central nervous system. Cancer 34:1293–1302
Zimmerman HM (1975) Malignant lymphomas of the nervous system. Acta Neuropathol Suppl Suppl 6:69–74
Fitzsimmons A, Upchurch K, Batchelor T (2005) Clinical features and diagnosis of primary central nervous system lymphoma. Hematol Oncol Clin North Am 19:689–703, vii
Rubenstein JL, Hsi ED, Johnson JL, Jung SH, Nakashima MO, Grant B, Cheson BD, Kaplan LD (2013) Intensive chemotherapy and immunotherapy in patients with newly diagnosed primary CNS lymphoma: CALGB 50202 (Alliance 50202). J Clin Oncol 31:3061–3068
Abrey LE, Batchelor TT, Ferreri AJ, Gospodarowicz M, Pulczynski EJ, Zucca E, Smith JR, Korfel A, Soussain C, DeAngelis LM, Neuwelt EA, O’Neill BP, Thiel E, Shenkier T, Graus F, van den Bent M, Seymour JF, Poortmans P, Armitage JO, Cavalli F (2005) Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. J Clin Oncol 23:5034–5043
Balmaceda C, Gaynor JJ, Sun M, Gluck JT, DeAngelis LM (1995) Leptomeningeal tumor in primary central nervous system lymphoma: recognition, significance, and implications. Ann Neurol 38:202–209
Fischer L, Martus P, Weller M, Klasen HA, Rohden B, Roth A, Storek B, Hummel M, Nagele T, Thiel E, Korfel A (2008) Meningeal dissemination in primary CNS lymphoma: prospective evaluation of 282 patients. Neurology 71:1102–1108
Glantz MJ, Cole BF, Glantz LK, Cobb J, Mills P, Lekos A, Walters BC, Recht LD (1998) Cerebrospinal fluid cytology in patients with cancer: minimizing false-negative results. Cancer 82:733–739
Olson ME, Chernik NL, Posner JB (1974) Infiltration of the leptomeninges by systemic cancer. A clinical and pathologic study. Arch Neurol 30:122–137
Wasserstrom WR, Glass JP, Posner JB (1982) Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 49:759–772
Scott BJ, Douglas VC, Tihan T, Rubenstein JL, Josephson SA (2013) A systematic approach to the diagnosis of suspected central nervous system lymphoma. JAMA Neurol 70:311–319
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Scharf, E.L., Hanson, C.A., Howard, M.T. et al. Serial cerebrospinal fluid examinations to diagnose hematological malignancy causing neurological disease. J Neurooncol 129, 77–83 (2016). https://doi.org/10.1007/s11060-016-2140-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-016-2140-y