© 2001 by Society
© 2001 by the Society forNeuro-Oncology
A comparison between ventricular and lumbar cerebrospinal `uid cytologyin adult patients with leptomeningeal metastases
Kaiser Permanente Medical Group, Department ofNeurology, Baldwin Park, CA 91706 (M.C.C.); Departmentof Nursing, University of California at San Diego, San Diego, CA 92103(P.A.K.); and University of Massachusetts, School ofPublic Health and Health Sciences, Amherst, MA 01003 (M.J.G.)
1 Address correspondence and reprint requests to Marc C. Chamberlain, KaiserPermanente Medical Group, Department of Neurology, 1011 Baldwin Park Blvd.,Baldwin Park, CA 91706.
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Abstract |
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Leptomeningeal metastases (LMs) are common metastatic complications,occurring in at least 5% of patients with disseminated cancer. Cerebrospinal`uid (CSF) cytology remains the standard for diagnosis and assessment oftreatment response, but may be inadequate. Our objective was to compareventricular and lumbar CSF cytology in patients who had cytologically provenLM and were receiving intra-CSF chemotherapy. Sixty patients with LM, positivelumbar CSF cytology documented at diagnosis, limited extent of CNS disease,and no evidence of CSF `ow obstruction were treated with a variety ofintra-CSF chemotherapies. All patients underwent a single simultaneousventricular and lumbar CSF sampling (mean volume of CSF per site examined, 10ml) to assess response to therapy at either 1 or 2 months after treatmentinitiation. Ventricular CSF cytology was positive in 44 patients (73%), 35 ofwhom were also positive by lumbar CSF cytology. Lumbar CSF cytology waspositive in 45 patients (75%), of which 35 were also positive by ventricularCSF cytology. Samples were negative at both ventricular and lumbar sites in 6patients (10%). Paired CSF cytologies were discordant in 19 (32%) patients.The lumbar cytology was negative in 9, whereas the ventricular cytology waspositive (lumbar false-negative rate of 17%); the ventricular cytology wasnegative in 10, whereas the lumbar cytology was positive (ventricularfalse-negative rate of 20%). In the presence of spinal signs or symptoms ofLM, the lumbar CSF cytology was more likely to be positive than was theventricular (odds ratio = 2.86; 95% confidence interval, 0.86-9.56).Conversely, in the presence of cranial signs or symptoms, the ventricular CSFcytology 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, whoseLM was documented initially by positive lumbar CSF cytology, ventricular andlumbar CSF samples obtained during treatment had similar false-negative rates,depending on the site of clinical or radiologic disease. This suggests thatboth lumbar and ventricular sites must be sampled when assessing treatmentresponse. If clinical or radiographic disease is present only at 1 site, thenCSF from that site is more likely to be positive than is CSF obtained from themore distant site.
Received June 6, 2000; Accepted August 17, 2000
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