Detection of central nervous system involvement in childhood acute lymphoblastic leukemia by cytomorphology and flow cytometry of the cerebrospinal fluid

Ranta, Susanna; Nilsson, Frans; Harila‐Saari, Arja; Saft, Leonie; Tani, Edneia; Söderhäll, Stefan; Porwit, Anna; Hultdin, Magnus; Norén‐Nyström, Ulrika; Heyman, Mats

doi:10.1002/pbc.25363

Cited by 50 publications

(69 citation statements)

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“…All but two patients with facial palsy and one of the three patients with hearing loss who underwent imaging had findings consistent with CNS involvement. In concordance with previous studies, 5,18 we found that patients with cranial nerve palsy rarely had leukemic cells in the CSF and MRI may be a useful addition in diagnosis of these patients.…”

Section: Discussionsupporting

confidence: 92%

Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis

Ranta

Palomäki

Levinsen

et al. 2016

Pediatric Blood & Cancer

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Section: Discussionsupporting

confidence: 92%

Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis

Ranta

Palomäki

Levinsen

et al. 2016

Pediatric Blood & Cancer

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“…No evidence from our SR informed this statement; however, evidence identified outside our SR indicated that flow cytometry can effectively detect disease in CSF samples from patients with ALL 261,262 and can detect subtle leukemic involvement in some cytologically negative CSF samples from both pediatric and adult patients with B-ALL and T-ALL. 263,264 Moreover, patients with ALL and CSF disease not detected by visual inspection of cytocentrifuge preparations but detectable by flow cytometry involvement have shorter OS times than do those with no involvement detected by flow cytometry (P ¼ .01 on multivariate analysis).…”

mentioning

confidence: 75%

Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology

Arber¹,

Borowitz²,

Cessna³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia.Objective.-To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage.Design.-The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus.Results.-Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported.Conclusions.-The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.

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“…A total of 41 studies comparing flow cytometry and cytology in CSF samples from patients with lymphoid neoplasia were identified .…”

Section: Resultsmentioning

confidence: 99%

“…47 Regarding study populations, 17/27 include only proven hematological diagnoses with risk factors or signs/symptoms suggestive for CNS dissemination, whereas 2/27 comprise a mixture of proven and suspected hematological diagnoses. Moreover, 6/27 comprise only cases of acute lymphoblastic leukemia/lymphoma 8,17,25,[28][29][30] and 2/27 encompass only cases of T-cell lymphoma. 24,32 Analytical informations are summarized in Table III.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of flow cytometry and cytomorphology for the diagnosis of meningeal involvement in lymphoid neoplasms: A systematic review

Canovi

Campioli

2016

Diagnostic Cytopathology

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Central nervous system (CNS) involvement by lymphoid neoplasms is a relatively infrequent event that demands accurate identification. The purpose of this article is to review studies comparing diagnostic accuracy of flow cytometry (FCM) and cytomorphology (CM) for meningeal involvement from lymphoid neoplasms. Primary publications from the last 26 years were identified searching MedLine, Scopus, and Web of Science and systematically scanning bibliographies of identified articles. Only studies reporting complete results were included. We assessed study quality using the QUADAS‐2 tool. For each study, we extracted informations regarding study population, technical details about sample preparation, data analysis, and results. Twenty‐seven studies were included. A great heterogeneity regarding study populations and analytical procedures was observed among studies. Percentages of samples giving a positive result with both FCM and CM range from 0.3% to 42.9% among studies, whereas double negative samples go from 0% to 96.3%. Samples with positive FCM but negative CM are reported by 89% (24/27) of the studies with rates ranging from 3.5% to 61.5% of total specimens. On the contrary, samples with positive CM and negative FCM are found in 48% (13/27) of the studies with percentages ranging from 0.5% to 10%. Despite all the differences observed among studies, almost all of them state that employing flow cytometry along with conventional cytology increases the number of positive CSF samples for lymphoma involvement, although a few cases remain in whom only morphology can correctly identify malignant cells. Diagn. Cytopathol. 2016;44:841–856. © 2016 Wiley Periodicals, Inc.

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Detection of central nervous system involvement in childhood acute lymphoblastic leukemia by cytomorphology and flow cytometry of the cerebrospinal fluid

Abstract: FCI of the CSF increased the detection rate of CNS involvement of ALL approximately two times compared to cytomorphology. Patients with low-level CNS involvement may benefit from additional intensified systemic or CNS-directed therapy, but larger studies are needed.

Cited by 50 publications

References 29 publications

Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis

Role of neuroimaging in children with acute lymphoblastic leukemia and central nervous system involvement at diagnosis

Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology

Accuracy of flow cytometry and cytomorphology for the diagnosis of meningeal involvement in lymphoid neoplasms: A systematic review

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