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Cerebrospinal fluid cytology in patients with cancer
Author(s) -
Glantz Michael J.,
Cole Bernard F.,
Glantz Lisa K.,
Cobb Janet,
Mills Pamela,
Lekos Andrew,
Walters Beverly C.,
Recht Lawrence D.
Publication year - 1998
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19980215)82:4<733::aid-cncr17>3.0.co;2-z
Subject(s) - medicine , cytology , cerebrospinal fluid , sampling (signal processing) , cancer , pathology , meningeal carcinomatosis , computer vision , filter (signal processing) , computer science
BACKGROUND Detection of malignant cells on cytologic examination of the cerebrospinal fluid (CSF) is the diagnostic gold standard for leptomeningeal carcinomatosis. The absence of cells is a primary endpoint for most therapeutic trials. Unfortunately, false‐negative results are common. Practical strategies are necessary to remedy this problem. METHODS Four physician‐dependent variables (CSF sample volume, site of CSF sampling, processing time, and frequency of CSF sampling) were identified, and their contributions to the false‐negative rate of CSF cytology were evaluated prospectively in 39 patients with leptomeningeal carcinomatosis. Retrospective data were analyzed to estimate the importance of these variables in daily practice. RESULTS False‐negative CSF cytology results correlated with small CSF volume ( P < 0.001), delayed processing ( P < 0.001), not obtaining CSF from a site of symptomatic or radiographically demonstrated disease ( P = 0.02), and sampling fewer than two times ( P < 0.001). In 1 year, 97% of CSF specimens at the study institution were of inadequate volume; >25% were processed too slowly. CONCLUSIONS False‐negative CSF cytology results are common, but can be minimized by: 1) withdrawing at least 10.5 mL of CSF for cytologic analysis; 2) processing the CSF specimen immediately; 3) obtaining CSF from a site of known leptomeningeal disease; and 4) repeating this procedure once if the initial cytology is negative. Cancer 1998;82:733‐9. © 1998 American Cancer Society.