title: Rare cell capture technology for the diagnosis of leptomeningeal metastasis in solid tumors.
abstract: OBJECTIVE
  To evaluate the utility of rare cell capture technology (RCCT) in the diagnosis of leptomeningeal metastasis (LM) from solid tumors through identification of circulating tumor cells (CTCs) in the CSF.
  
  
  METHODS
  In this pilot study, CSF samples from 60 patients were analyzed. The main patient cohort consisted of 51 patients with solid tumors undergoing lumbar puncture for clinical suspicion of LM. Those patients underwent initial MRI evaluation and had CSF analyzed through conventional cytology and for the presence of CTCs using RCCT, based on immunomagnetic platform enrichment utilizing anti-epithelial cell adhesion molecule antibody-covered magnetic nanoparticles. An additional 9 patients with CSF pleocytosis but without solid tumors were separately analyzed to ensure accurate differentiation between CTCs and leukocytes.
  
  
  RESULTS
  Among the 51 patients with solid tumors, 15 patients fulfilled criteria for LM. CSF CTCs were found in 16 patients (median 20.7 CTCs/mL, range 0.13 to >150), achieving a sensitivity of 100% as compared with 66.7% for conventional cytology and 73.3% for MRI. One patient had a false-positive CSF CTC result (specificity = 97.2%); however, that patient eventually met LM criteria 6 months after the tap. CSF CTCs were not found in any of the additional 9 patients with CSF pleocytosis.
  
  
  CONCLUSIONS
  RCCT is an accurate, novel method for the detection of LM in solid tumors, potentially providing earlier diagnostic confirmation and sparing patients from repeat lumbar punctures.
authors.affiliation: Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Nayak
authors.forename: Martin
authors.initials: M
authors.lastname: Fleisher
authors.forename: Rita
authors.initials: R
authors.lastname: Gonzalez-Espinoza
authors.forename: Oscar
authors.initials: O
authors.lastname: Lin
authors.forename: Katherine
authors.initials: K
authors.lastname: Panageas
authors.forename: Anne
authors.initials: A
authors.lastname: Reiner
authors.forename: Chhui-Mei
authors.initials: CM
authors.lastname: Liu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Deangelis
authors.forename: Antonio
authors.initials: A
authors.lastname: Omuro
mesh_terms: D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D006801:Humans; D018189:Immunomagnetic Separation / Q000379:methods*; D008297:Male; D055756:Meningeal Carcinomatosis / Q000175:diagnosis* / Q000556:secondary*; D009369:Neoplasms / Q000134:cerebrospinal fluid*; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D010865:Pilot Projects
references.citation: N Engl J Med. 2004 Aug 19;351(8):781-91
references.pmid: 15317891
references.citation: Clin Cancer Res. 2004 Oct 15;10(20):6897-904
references.pmid: 15501967
references.citation: Neurology. 2006 Jul 11;67(1):114-9
references.pmid: 16832089
references.citation: Oncotarget. 2011 Oct;2(10):752-60
references.pmid: 21987585
references.citation: Curr Opin Genet Dev. 2010 Feb;20(1):96-9
references.pmid: 20071161
references.citation: Ann Neurol. 1995 Jul;38(1):51-7
references.pmid: 7611725
references.citation: Clin Cancer Res. 2007 Dec 1;13(23):7053-8
references.pmid: 18056182
references.citation: J Neurooncol. 2005 Oct;75(1):85-99
references.pmid: 16215819
references.citation: J Neurooncol. 2010 Feb;96(3):375-84
references.pmid: 19609489
references.citation: J Neurooncol. 2009 Jun;93(2):205-12
references.pmid: 19043775
references.citation: Br J Haematol. 2004 Mar;124(6):762-8
references.pmid: 15009064
references.citation: Cancer. 2005 Jun 1;103(11):2344-8
references.pmid: 15844174
references.citation: Neurology. 1979 Oct;29(10):1369-75
references.pmid: 573381
references.citation: J Neurol. 2006 Sep;253(9):1177-84
references.pmid: 16998648
references.citation: J Neurooncol. 2009 Sep;94(2):229-34
references.pmid: 19267183
references.citation: Clin Cancer Res. 2007 Feb 1;13(3):920-8
references.pmid: 17289886
references.citation: J Thorac Oncol. 2012 Feb;7(2):382-5
references.pmid: 22089116
references.citation: Lancet Oncol. 2009 Mar;10(3):233-9
references.pmid: 19213602
references.citation: J Neurol. 1999 Sep;246(9):810-4
references.pmid: 10525979
references.citation: Cancer. 1982 Feb 15;49(4):759-72
references.pmid: 6895713
references.citation: Semin Oncol. 2009 Aug;36(4 Suppl 2):S35-45
references.pmid: 19660682
references.citation: Neurology. 2010 May 4;74(18):1449-54
references.pmid: 20439847
references.citation: Neurology. 2000 Apr 25;54(8):1670-6
references.pmid: 10762512
references.citation: Clin Chem Lab Med. 2009;47(7):874-9
references.pmid: 19453289
references.citation: Br J Cancer. 2004 Jul 19;91(2):219-24
references.pmid: 15213721
references.citation: Neurology. 2005 Oct 11;65(7):1120-2
references.pmid: 16217072
references.citation: Hum Pathol. 2004 Jan;35(1):122-8
references.pmid: 14745734
references.citation: J Neurol Sci. 2004 Aug 30;223(2):167-78
references.pmid: 15337619
references.citation: Cancer Treat Res. 2005;125:17-30
references.pmid: 16211881
references.citation: Cancer. 1993 Oct 15;72(8):2376-82
references.pmid: 8402452