Cerebrospinal Fluid (Csf) Cytology: Factors Impacting on Diagnostic Yield

Connor, Antoinette O'; McFeely, Orla; Bermingham, Niamh; Sullivan, Sean O'

doi:10.1136/jnnp-2016-315106.195

Cited by 4 publications

(4 citation statements)

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“…Abnormal CSF cytology was seen in only a quarter of the patients in this study. Other studies suggest the volume and number of CSF samples sent increases diagnostic yield for all CNS or proximal nerve root involved malignancies, but this was not seen in our cohort 21 . If present, abnormal CSF cytology was detected on first examination.…”

Section: Discussioncontrasting

confidence: 52%

Peripheral nerve neurolymphomatosis: Clinical features, treatment, and outcomes

et al. 2020

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This series characterises nine patients with neurohistopathologically proven peripheral nerve neurolymphomatosis. A search of the hospital neuropathology database from 2002 to 2019 identified biopsy proven cases. Clinical data, investigation modalities, treatments, and outcomes were collated. Median age at neuropathy onset was 47 y, the neuropathy commonly as the initial lymphoma disease manifestation. Most (8/9) presented with painful asymmetrical sensory disturbance, with additional cranial nerve involvement in three. Neurophysiology typically demonstrated multiple axonal mononeuropathies. Cerebrospinal fluid protein was often raised (6/8). Magnetic resonance imaging suggested peripheral nerve infiltration in 6/9 and positron emission tomography CT in 4/9. Bone marrow biopsy was abnormal in 6/8. Treatment involved systemic or intrathecal chemotherapy and radiotherapy. Median survival was 23 mo. Neurolymphomatosis is a rare but important cause of neuropathy, particularly in those lacking systemic evidence of lymphoma as correct aggressive treatment can prolong survival. Nerve biopsy is essential to classify lymphoma type and rule out alternatives.

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Section: Discussioncontrasting

confidence: 52%

Peripheral nerve neurolymphomatosis: Clinical features, treatment, and outcomes

et al. 2020

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“…Cytology has been negative in 10%–15% of patients with unequivocal LMD and can remain negative in up to 14% even after three studies, regardless of where the CSF is sampled—lumbar, cisternal or ventricular sites 1 8. In our case, the fluid sent for analysis was only 2 mL and therefore likely to represent a false negative result in the milieu of a clinical and radiographical presentation highly suspicious for LMD 9. Opening pressure of CSF was also unequivocally elevated at 290 mm H 2 O even with consideration of normative values adjusted for age and BMI 10.…”

Section: Discussionmentioning

confidence: 61%

Leptomeningeal disease in BRIP1-mutated pancreatic adenocarcinoma

Yim

Leung

2022

BMJ Case Rep

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Leptomeningeal disease is rare in pancreatic cancer and prognosis remains poor. Mutation profiles are now directing therapy to improve survival. We describe a case of leptomeningeal and brain metastasis in BRCA1 interacting protein 1, or BRIP1-mutated pancreatic adenocarcinoma with progression through several lines of chemotherapy and immunotherapy. A woman in her late 50s presented with metastatic pancreatic adenocarcinoma on liver biopsy. She achieved complete response after modified FOLFIRINOX and started a poly (ADP-ribose) polymerase (PARP) inhibitor for a BRIP1 mutation. She had recurrence at 9 months and started pembrolizumab (programmed cell death protein 1, or PD-1receptor antibody) for tumour mutational burden of 10 muts/Mb. At 10 months, she presented with lower extremity weakness and back pain. MRI revealed leptomeningeal metastases from T11 to cauda equina roots and right occipital metastasis. Cerebrospinal fluid studies revealed elevated pressure (290 mm H2O) and protein (73 mg/dL) with negative cytology. Leptomeningeal carcinomatosis was diagnosed. She began palliative radiation but died at 11 months from initial diagnosis.

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“…It is subjective to input and variability in interpretation could occur. This is not helpful for reaching a definite diagnosis but provides support and insight [58] 2. Flow Cytometry (FCM)…”

Section: Conventional Cytologymentioning

confidence: 99%

A Clinical Audit: Assessing the Diagnostic Delay of Primary Brain Tumors, Glioblastoma IDH-Wild Type and Primary CNS Lymphoma; Exploring the Use of CSF Liquid Biopsy

Ghosheh

2023

SVOANE

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Background: Diagnostic delay is a critical issue in healthcare, often leading to delayed treatment and poor patient outcomes. Diagnostic errors contribute to about 10% of patient deaths annually. Delays are very prevalent in Glioblastoma and Primary CNS Lymphoma. Both have an aggressive nature and a short survival rate, which urges for early diagnosis to ensue treatment as quick as possible. The delayed diagnosis can be attributed to tumor-specific factors such as challenging differential diagnoses, inadequate methods in achieving optimal outcomes, and the presence of confounding factors like steroid usage. Aims and Objectives: The objective of this clinical audit is to analyse patient records within an oncology unit. The primary goal is to assess the quality of practice by evaluating the standards of diagnosis and treatment. Additionally, the audit aims to pinpoint areas that require improvement at every stage of patient management, encompassing administration, symptom evaluation, and post-therapeutic measures. Based on these findings, a comprehensive plan of action will be proposed to address the identified issues effectively. Standards and Methods: In this Clinical Audit, we assessed the adherence of 10 Glioblastoma and PCNSL patients in a neuro oncology unit, to standards and guidelines set by professional medical associations. Which include World Health Organisation (WHO), National Health Service England (NHS), and European Association of Neuro-oncology (EANO). Results: Our cohort showed long diagnostic delays, minimum and maximum values of 30 and 1825 days. The sample did not show significantly longer delays compared to other PCNSL or HGG patients, all collected from the literature, with p values of 0.174 and 0.637, respectively. Conclusions: In Conclusion, Diagnostic Delay attributed to PCNSL and Glioblastoma can be pinpointed to the inadequacy of existing standards in relying solely on stereotactic biopsies for definite diagnosis when it may not be ideal for all patients at all tumor stages. A plan of action encouraging large clinical trials of CSF Liquid Biopsy is recommended with an employment of recent advances and focusing on detecting circular tumor DNA for the diagnostic insight it provides. As well as exploring its use during or post therapy to monitor the lesion and pathology. To also adhere strictly to the discouragement of steroid use for the negative prognostic factors it causes.

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Cerebrospinal Fluid (Csf) Cytology: Factors Impacting on Diagnostic Yield

Cited by 4 publications

References 0 publications

Peripheral nerve neurolymphomatosis: Clinical features, treatment, and outcomes

Peripheral nerve neurolymphomatosis: Clinical features, treatment, and outcomes

Leptomeningeal disease in BRIP1-mutated pancreatic adenocarcinoma

A Clinical Audit: Assessing the Diagnostic Delay of Primary Brain Tumors, Glioblastoma IDH-Wild Type and Primary CNS Lymphoma; Exploring the Use of CSF Liquid Biopsy

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