title: Meningeal dissemination in primary CNS lymphoma: prospective evaluation of 282 patients.
abstract: BACKGROUND
  The impact of meningeal dissemination in primary CNS lymphoma (PCNSL) is debated, and the reported frequency varies. We prospectively evaluated the diagnostic value of PCR in comparison with CSF cytomorphology and MRI for diagnosing meningeal dissemination in PCNSL.
  
  
  METHODS
  We evaluated 282 patients from a multicenter therapy study for PCNSL for the presence of meningeal dissemination: 205 with CSF cytomorphology, 171 with PCR of the rearranged immunoglobulin heavy-chain genes in CSF, and 217 with cranial MRI.
  
  
  RESULTS
  Meningeal dissemination was found in 33 of 205 patients (16%) by cytomorphology, in 19 of 171 (11%) patients evaluated by PCR, and in 8 of 217 patients (4%) by MRI. Considering either of these methods, the relative frequency of meningeal dissemination was 17.4% (49 of 282 patients). PCR was monoclonal in 6 of 19 (32%) samples with positive cytomorphology, 1 of 13 samples (8%) with suspicious cytology, and in 10 of 105 (10%) cytologically negative samples. In 11 samples with positive and 12 with suspicious cytology, PCR showed only a polyclonal pattern. The probability of meningeal dissemination detection was higher in cases with CSF pleocytosis (>5/microL) with an OR of 2.48 (95% CI 1.15-5.34, p = 0.018). CSF protein had no predictive value for meningeal dissemination detection.
  
  
  CONCLUSIONS
  We found a low rate of meningeal dissemination in primary CNS lymphoma in this large prospective study. The rate of discordant PCR and cytomorphologic results was high. Thus, the methods should be regarded as complementary. CSF pleocytosis had predictive value for meningeal dissemination detection.
authors.affiliation: Department of Hematology, Oncology & Transfusion Medicine, Charité Campus Benjamin Franklin, Berlin, Germany. lars.fischer@charite.de
authors.forename: L
authors.initials: L
authors.lastname: Fischer
authors.forename: P
authors.initials: P
authors.lastname: Martus
authors.forename: M
authors.initials: M
authors.lastname: Weller
authors.forename: H A
authors.initials: HA
authors.lastname: Klasen
authors.forename: B
authors.initials: B
authors.lastname: Rohden
authors.forename: A
authors.initials: A
authors.lastname: Röth
authors.forename: B
authors.initials: B
authors.lastname: Storek
authors.forename: M
authors.initials: M
authors.lastname: Hummel
authors.forename: T
authors.initials: T
authors.lastname: Nägele
authors.forename: E
authors.initials: E
authors.lastname: Thiel
authors.forename: A
authors.initials: A
authors.lastname: Korfel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002452:Cell Count / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D003584:Cytological Techniques / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000032:analysis / Q000097:blood; D008223:Lymphoma / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000556:secondary*; D008578:Meninges / Q000473:pathology; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis* / Q000276:immunology; D016133:Polymerase Chain Reaction / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results
chemical_list: D007143:Immunoglobulin Heavy Chains