A comparison between ventricular and lumbar cerebrospinal fluid cytology in adult patients with leptomeningeal metastases
A comparison between ventricular and lumbar cerebrospinal fluid cytology in adult patients with leptomeningeal metastases
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DOI：
10.1093/neuonc/3.1.42
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发表时间：
2001-01-01
期刊：
影响因子：
15.9
通讯作者：
Glantz, MJ
中科院分区：
文献类型：
--
作者：
Chamberlain, MC;Kormanik, PA;Glantz, MJ
软脑膜转移（LM）是常见的转移性并发症，至少5%的扩散性癌症患者会发生这种情况。脑脊液（CSF）细胞学检查仍然是诊断和评估治疗反应的标准，但可能是不够的。我们的目的是比较细胞学证实LM并接受CSF内化疗的患者的脑室和腰椎CSF细胞学。60例LM患者，诊断时腰椎CSF细胞学检查阳性，CNS疾病程度有限，无CSF流动阻塞证据，接受各种CSF内化疗。所有患者在治疗开始后1个月或2个月接受单次同时脑室和腰椎CSF采样（每个检查部位的平均CSF体积，10 ml），以评估对治疗的反应。44例患者（73%）脑室CSF细胞学阳性，其中35例腰椎CSF细胞学也阳性。45例患者（75%）腰椎CSF细胞学检查阳性，其中35例脑室CSF细胞学检查也阳性。6例患者（10%）的脑室和腰椎部位样本均为阴性。19例（32%）患者的成对CSF细胞学检查结果不一致。9例腰椎细胞学阴性，而脑室细胞学阳性（腰椎假阴性率为17%）; 10例脑室细胞学阴性，而腰椎细胞学阳性（脑室假阴性率为20%）。在存在LM的脊髓体征或症状时，腰椎CSF细胞学检查比心室细胞学检查更有可能呈阳性（比值比= 2.86; 95%置信区间，0.86-9.56）。相反，在存在颅内体征或症状的情况下，脑室CSF细胞学阳性的可能性高于腰椎（比值比= 2.71; 95%置信区间，0.76-9.71）。在该队列中，最初通过阳性腰椎CSF细胞学记录LM的患者中，治疗期间获得的脑室和腰椎CSF样本具有相似的假阴性率，这取决于临床或放射学疾病的部位。这表明，在评估治疗反应时，必须对腰椎和心室部位进行采样。如果临床或影像学疾病仅出现在一个部位，则该部位的CSF比从更远部位获得的CSF更可能是阳性的。
Leptomeningeal metastases (LMs) are common metastatic complications, occurring in at least 5% of patients with disseminated cancer. Cerebrospinal fluid (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 flow 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% confidence 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% confidence 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.