Comparison of lumbar and shunt cerebrospinal fluid specimens for cytologic detection of leptomeningeal disease in pediatric patients with brain tumors

Amor Gajjar, Maryam Fouladi, Andrew W. Walter, Stephen J. Thompson, David A. Reardon, Thomas E. Merchant, Jesse J. Jenkins, Aiyi Liu, James M. Boyett, Larry E. Kun, Richard L. Heideman

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Purpose: Leptomeningeal disease (LMD) significantly affects the prognosis and treatment of pediatric patients with primary CNS tumors. Cytologic examination of lumbar CSF is routinely used to detect LMD. To determine whether examination of CSF obtained from ventricular shunt taps is a more sensitive method of detecting LMD in these patients, we designed a prospective study to compare the findings of cytologic examinations of CSF obtained from concurrent lumbar and ventriculoperitoneal (VP) shunt tops. Patients and Methods: As a part of diagnostic staging, follow-up testing, or both, 52 consecutive patients underwent concurrent lumbar and shunt tops on 90 separate occasions, ranging from the time of diagnosis to treatment follow-up. CSF from both sites was examined cytologically for malignant cells. Results: The median age of the 28 males and 24 females was 7.5 years (range, 0.6 to 21.4 years). The primary CNS tumors included medulloblastoma (n = 29), astrocytoma (n = 10), ependymoma (n = 5), germinoma (n = 3), atypical teratoid rhabdoid tumor (n = 2), choroid plexus carcinoma (n = 2), and pineoblastoma (n = 1). Each site yielded a median CSF volume of 1.0 mL. Fourteen of 90 paired CSF test results were discordant: in 12, the cytologic findings from shunt CSF were negative for malignant cells, but those from lumbar CSF were positive; in two, the reverse was true. Malignant cells were detected at a higher rate in lumbar CSF than in shunt CSF (P = .0018). When repeat analyses were excluded, examination of lumbar CSF remained significantly more sensitive in detecting malignant cells (P = .011). Analysis of the subset of patients with embryonal tumors showed similar results (P = .0008). Conclusion: Cytologic examination of lumbar CSF is clearly superior to cytologic examination of VP shunt CSF for detecting leptomeningeal metastases in pediatric patients with primary CNS tumors.

Original languageEnglish (US)
Pages (from-to)1825-1828
Number of pages4
JournalJournal of Clinical Oncology
Volume17
Issue number6
StatePublished - Jun 1 1999

Fingerprint

Cerebrospinal Fluid Shunts
Brain Neoplasms
Pediatrics
Ventriculoperitoneal Shunt
Neoplasms
Germinoma
Pinealoma
Ependymoma
Medulloblastoma
Astrocytoma
Prospective Studies
Neoplasm Metastasis
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Gajjar, A., Fouladi, M., Walter, A. W., Thompson, S. J., Reardon, D. A., Merchant, T. E., ... Heideman, R. L. (1999). Comparison of lumbar and shunt cerebrospinal fluid specimens for cytologic detection of leptomeningeal disease in pediatric patients with brain tumors. Journal of Clinical Oncology, 17(6), 1825-1828.

Comparison of lumbar and shunt cerebrospinal fluid specimens for cytologic detection of leptomeningeal disease in pediatric patients with brain tumors. / Gajjar, Amor; Fouladi, Maryam; Walter, Andrew W.; Thompson, Stephen J.; Reardon, David A.; Merchant, Thomas E.; Jenkins, Jesse J.; Liu, Aiyi; Boyett, James M.; Kun, Larry E.; Heideman, Richard L.

In: Journal of Clinical Oncology, Vol. 17, No. 6, 01.06.1999, p. 1825-1828.

Research output: Contribution to journalArticle

Gajjar, A, Fouladi, M, Walter, AW, Thompson, SJ, Reardon, DA, Merchant, TE, Jenkins, JJ, Liu, A, Boyett, JM, Kun, LE & Heideman, RL 1999, 'Comparison of lumbar and shunt cerebrospinal fluid specimens for cytologic detection of leptomeningeal disease in pediatric patients with brain tumors', Journal of Clinical Oncology, vol. 17, no. 6, pp. 1825-1828.
Gajjar, Amor ; Fouladi, Maryam ; Walter, Andrew W. ; Thompson, Stephen J. ; Reardon, David A. ; Merchant, Thomas E. ; Jenkins, Jesse J. ; Liu, Aiyi ; Boyett, James M. ; Kun, Larry E. ; Heideman, Richard L. / Comparison of lumbar and shunt cerebrospinal fluid specimens for cytologic detection of leptomeningeal disease in pediatric patients with brain tumors. In: Journal of Clinical Oncology. 1999 ; Vol. 17, No. 6. pp. 1825-1828.
@article{02f1fcd7d45f4773a5fa4f70647446f2,
title = "Comparison of lumbar and shunt cerebrospinal fluid specimens for cytologic detection of leptomeningeal disease in pediatric patients with brain tumors",
abstract = "Purpose: Leptomeningeal disease (LMD) significantly affects the prognosis and treatment of pediatric patients with primary CNS tumors. Cytologic examination of lumbar CSF is routinely used to detect LMD. To determine whether examination of CSF obtained from ventricular shunt taps is a more sensitive method of detecting LMD in these patients, we designed a prospective study to compare the findings of cytologic examinations of CSF obtained from concurrent lumbar and ventriculoperitoneal (VP) shunt tops. Patients and Methods: As a part of diagnostic staging, follow-up testing, or both, 52 consecutive patients underwent concurrent lumbar and shunt tops on 90 separate occasions, ranging from the time of diagnosis to treatment follow-up. CSF from both sites was examined cytologically for malignant cells. Results: The median age of the 28 males and 24 females was 7.5 years (range, 0.6 to 21.4 years). The primary CNS tumors included medulloblastoma (n = 29), astrocytoma (n = 10), ependymoma (n = 5), germinoma (n = 3), atypical teratoid rhabdoid tumor (n = 2), choroid plexus carcinoma (n = 2), and pineoblastoma (n = 1). Each site yielded a median CSF volume of 1.0 mL. Fourteen of 90 paired CSF test results were discordant: in 12, the cytologic findings from shunt CSF were negative for malignant cells, but those from lumbar CSF were positive; in two, the reverse was true. Malignant cells were detected at a higher rate in lumbar CSF than in shunt CSF (P = .0018). When repeat analyses were excluded, examination of lumbar CSF remained significantly more sensitive in detecting malignant cells (P = .011). Analysis of the subset of patients with embryonal tumors showed similar results (P = .0008). Conclusion: Cytologic examination of lumbar CSF is clearly superior to cytologic examination of VP shunt CSF for detecting leptomeningeal metastases in pediatric patients with primary CNS tumors.",
author = "Amor Gajjar and Maryam Fouladi and Walter, {Andrew W.} and Thompson, {Stephen J.} and Reardon, {David A.} and Merchant, {Thomas E.} and Jenkins, {Jesse J.} and Aiyi Liu and Boyett, {James M.} and Kun, {Larry E.} and Heideman, {Richard L.}",
year = "1999",
month = "6",
day = "1",
language = "English (US)",
volume = "17",
pages = "1825--1828",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "6",

}

TY - JOUR

T1 - Comparison of lumbar and shunt cerebrospinal fluid specimens for cytologic detection of leptomeningeal disease in pediatric patients with brain tumors

AU - Gajjar, Amor

AU - Fouladi, Maryam

AU - Walter, Andrew W.

AU - Thompson, Stephen J.

AU - Reardon, David A.

AU - Merchant, Thomas E.

AU - Jenkins, Jesse J.

AU - Liu, Aiyi

AU - Boyett, James M.

AU - Kun, Larry E.

AU - Heideman, Richard L.

PY - 1999/6/1

Y1 - 1999/6/1

N2 - Purpose: Leptomeningeal disease (LMD) significantly affects the prognosis and treatment of pediatric patients with primary CNS tumors. Cytologic examination of lumbar CSF is routinely used to detect LMD. To determine whether examination of CSF obtained from ventricular shunt taps is a more sensitive method of detecting LMD in these patients, we designed a prospective study to compare the findings of cytologic examinations of CSF obtained from concurrent lumbar and ventriculoperitoneal (VP) shunt tops. Patients and Methods: As a part of diagnostic staging, follow-up testing, or both, 52 consecutive patients underwent concurrent lumbar and shunt tops on 90 separate occasions, ranging from the time of diagnosis to treatment follow-up. CSF from both sites was examined cytologically for malignant cells. Results: The median age of the 28 males and 24 females was 7.5 years (range, 0.6 to 21.4 years). The primary CNS tumors included medulloblastoma (n = 29), astrocytoma (n = 10), ependymoma (n = 5), germinoma (n = 3), atypical teratoid rhabdoid tumor (n = 2), choroid plexus carcinoma (n = 2), and pineoblastoma (n = 1). Each site yielded a median CSF volume of 1.0 mL. Fourteen of 90 paired CSF test results were discordant: in 12, the cytologic findings from shunt CSF were negative for malignant cells, but those from lumbar CSF were positive; in two, the reverse was true. Malignant cells were detected at a higher rate in lumbar CSF than in shunt CSF (P = .0018). When repeat analyses were excluded, examination of lumbar CSF remained significantly more sensitive in detecting malignant cells (P = .011). Analysis of the subset of patients with embryonal tumors showed similar results (P = .0008). Conclusion: Cytologic examination of lumbar CSF is clearly superior to cytologic examination of VP shunt CSF for detecting leptomeningeal metastases in pediatric patients with primary CNS tumors.

AB - Purpose: Leptomeningeal disease (LMD) significantly affects the prognosis and treatment of pediatric patients with primary CNS tumors. Cytologic examination of lumbar CSF is routinely used to detect LMD. To determine whether examination of CSF obtained from ventricular shunt taps is a more sensitive method of detecting LMD in these patients, we designed a prospective study to compare the findings of cytologic examinations of CSF obtained from concurrent lumbar and ventriculoperitoneal (VP) shunt tops. Patients and Methods: As a part of diagnostic staging, follow-up testing, or both, 52 consecutive patients underwent concurrent lumbar and shunt tops on 90 separate occasions, ranging from the time of diagnosis to treatment follow-up. CSF from both sites was examined cytologically for malignant cells. Results: The median age of the 28 males and 24 females was 7.5 years (range, 0.6 to 21.4 years). The primary CNS tumors included medulloblastoma (n = 29), astrocytoma (n = 10), ependymoma (n = 5), germinoma (n = 3), atypical teratoid rhabdoid tumor (n = 2), choroid plexus carcinoma (n = 2), and pineoblastoma (n = 1). Each site yielded a median CSF volume of 1.0 mL. Fourteen of 90 paired CSF test results were discordant: in 12, the cytologic findings from shunt CSF were negative for malignant cells, but those from lumbar CSF were positive; in two, the reverse was true. Malignant cells were detected at a higher rate in lumbar CSF than in shunt CSF (P = .0018). When repeat analyses were excluded, examination of lumbar CSF remained significantly more sensitive in detecting malignant cells (P = .011). Analysis of the subset of patients with embryonal tumors showed similar results (P = .0008). Conclusion: Cytologic examination of lumbar CSF is clearly superior to cytologic examination of VP shunt CSF for detecting leptomeningeal metastases in pediatric patients with primary CNS tumors.

UR - http://www.scopus.com/inward/record.url?scp=0033063502&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033063502&partnerID=8YFLogxK

M3 - Article

VL - 17

SP - 1825

EP - 1828

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 6

ER -