Ch. Rhodes et al., A COMPARISON OF POLYMERASE CHAIN-REACTION EXAMINATION OF CEREBROSPINAL-FLUID AND CONVENTIONAL CYTOLOGY IN THE DIAGNOSIS OF LYMPHOMATOUS MENINGITIS, Cancer, 77(3), 1996, pp. 543-548
BACKGROUND. Inherent limitations of conventional cytology often result
in a failure to diagnose lymphomatous meningitis in cerebrospinal flu
id (CSF) specimens from patients who actually have the disease. The de
velopment of polymerase chain reaction (PCR) techniques for the diagno
sis of lymphoma based on the detection of clonal rearrangements of the
immunoglobulin or T-cell receptor genes offers an alternative, DNA-ba
sed test for the diagnosis of lymphoma in the CSF. METHODS. In this re
trospective study, 31 CSF specimens from 21 patients were examined by
a PCR technique that can detect clonal immunoglobulin gene rearrangeme
nts. Twenty-four of the specimens came from 14 patients who eventually
had definitive histologic or cytologic diagnoses of B-cell lymphoma.
The other seven patients had other neurologic diagnoses, including two
patients with reactive lymphocytosis, three with glioblastoma, one wi
th metastatic carcinoma, and one with multi-infarct dementia. The resu
lts of the PCR examinations were compared with cytologic evaluation of
the same CSF specimens. RESULTS. Five of seven specimens from patient
s with central nervous system lymphoma that were suspicious for, but n
ot diagnostic of, lymphoma by conventional cytology were positive by P
CR. Of 13 specimens from patients with lymphoma that showed no cytolog
ic evidence of malignancy, 5 were positive by PCR. Two of four specime
ns for which conventional cytology showed definitive evidence of lymph
oma were positive by PCR. Two specimens from patients with a reactive
lymphocytosis showed a polyclonal pattern by PCR. Specimens from patie
nts with other neurologic diseases were negative by PCR even when cyto
logically malignant (glioblastoma) cells were present in the specimen.
CONCLUSIONS. PCR examination of CSF is practical, complements convent
ional cytology, and sometimes provides the correct diagnosis when conv
entional cytology yields only ambiguous results. (C) 1996 American Can
cer Society.