The value of tandem CSF/MRI evaluation for predicting disseminated disease in childhood central nervous system neoplasms |
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Authors: | Judy Pang Anuradha Banerjee Tarik Tihan |
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Institution: | (1) Department of Pathology, Neuropathology Unit Room M551, UCSF School of Medicine, 505 Parnassus Avenue, San Francisco, CA 94143-0102, USA;(2) Department of Pediatric Hematology-Oncology, UCSF School of Medicine, San Francisco, CA, USA |
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Abstract: | Leptomeningeal spread of childhood primary central nervous system (CNS) neoplasms, also known as leptomeningeal disease (LMD),
significantly affects prognosis and treatment. Lumbar cerebrospinal fluid (CSF) cytology and spinal magnetic resonance imaging
(MRI) are considered critical for diagnosis of LMD. It has been suggested that either CSF cytology or spinal MRI alone would
miss LMD in up to 18% of children with CNS neoplasms. To determine the rate of LMD and the concordance of these two tests
at our institution, we analyzed the results of concurrent CSF cytology and spinal MRI (tandem CSF/MRI) performed at the UCSF
Pediatric Neuro-oncology Division. We identified all patients who underwent tandem CSF and MRI analysis during their treatment
between 1990 and 2005. There were 127 tandem analyses from 78 patients, of which 115 were concordant. Among the remaining
12 discordant tandem analyses, spinal MRI was positive and CSF was negative for tumor in 8 patients, while CSF was positive
and spinal MRI was normal in four others. In all discordant cases, positive spinal MRI was often associated with aggressive
disease. Positive CSF cytology correlated with aggressive disease only in one patient who had evidence of disseminated intracranial
tumor on MRI. In the absence of intracranial tumor spread or LMD on MRI, a positive CSF cytology did not correlate with aggressive
disease or recurrence. Even though the number of cases is limited, our findings suggest that a positive CSF cytology with
no other corroborating evidence of tumor spread or recurrence should be interpreted with caution. |
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Keywords: | Pediatric brain tumors Medulloblastoma CSF cytology Leptomeningeal disease |
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