Diagnostic strategies to investigate cerebrospinal fluid involvement in haematological malignancies
Dipartimento Ematologico, Istituto Nazionale Tumori, IRCCS "Fondazione Pascale", Naples, Italy. Leukemia research
(Impact Factor: 2.35).
12/2012; 37(3). DOI: 10.1016/j.leukres.2012.11.016
Central nervous system (CNS) involvement is a fatal complication of certain haematological malignancies with an incidence as high as 25% in specific leukaemia/lymphoma subtypes. It is often accompanied by 'occult' cerebrospinal fluid (CSF) involvement at diagnosis, which is frequently missed by conventional cytology examination. Unfortunately, a diagnostic gold standard is yet unavailable since CSF morphology may be negative for malignant cells in up to 45% of patients with suspected meningeal involvement. New technologies such as flow cytometry, molecular genetics and newer biomarkers may improve sensitivity and specificity facilitating the diagnosis of CNS involvement as well as effective prophylaxis and successful treatment.
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- "There is some recent evidence that CSF involvement may be missed by conventional cytology (Galati et al, 2013). New technologies , such as flow cytometry, molecular genetics and newer biomarkers may improve sensitivity and specificity in the diagnosis of CNS disease (Galati et al, 2013). Routine CSF cytology is undertaken on the basis that detection of asymptomatic CNS relapse may lead to earlier diagnosis of relapse, although there is no evidence to support that this may lead to improved outcome. "
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ABSTRACT: Central nervous system (CNS) involvement is a major complication of haematological and solid tumors with an incidence that ranges from 10% in solid malignances up to 25% in specific leukaemia or lymphoma subtypes. Cerebrospinal fluid (CSF) patterns are unspecific. Though CSF cytology has a high specificity (up to 95%), its sensitivity is generally less than 50% and no diagnostic gold standard marker is available, yet. New technologies such as flow cytometry, molecular genetics and newer biomarkers may improve diagnostic sensitivity and specificity, leading to the CNS involvement diagnosis, and consequently, to an effective prophylaxis and successful treatment.
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ABSTRACT: Cerebrospinal fluid (CSF) analysis is essential in the diagnosis of the infectious diseases of the central nervous system. It is also helpful in the differential diagnosis of other conditions that simulate infectious disorders and in monitoring the effects of antibiotic therapy.
The CSF is formed by the choroid plexuses of the ventricles. Its volume in adults is 150 ml. Most of the CSF is reabsorbed by the arachnoid granulations, located along the superior sagittal sinus toward the venous system. The main CSF function is mechanical, protecting the brain from acute or sudden changes in pressure.
The lumbar puncture (LP) to obtain CSF is not without risks, and the complications, such as brain herniation, spinal hematoma, and iatrogenic CNS infection, which, although rare, can be serious. Nevertheless, LP remains the gold standard procedure for the diagnosis of CNS infections. The LP should be performed in aseptic conditions with the patient assuming a lateral recumbent position. Local anesthesia at the needle insertion point makes the procedure easier. Using atraumatic needle is associated with less post-puncture headache, which is the commonest complication.
The normal CSF appears sparkling clear; any change in this characteristic is pathologic. The normal total CSF leukocyte counts are <5/mm3 in adults, the normal glucose level is between 45 and 80 mg/dl, and the normal total protein is between 15 and 50 mg/dl. An increased intrathecal synthesis of immunoglobulins indicates a chronic infection of the CSF. Microbiological analysis of the CSF includes stains; aerobic and anaerobic cultures for bacteria, fungi, virus, and tuberculosis; serologic testing; and viral and bacterial screen by PCR.
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