How to facilitate early diagnosis of CNS involvement in malignant lymphoma.
Making the diagnosis of secondary CNS involvement in lymphoma can be difficult due to unspecific signs and symptoms, limited accessibility of brain/myelon parenchyma and low sensitivity and/or specifity of imaging and cerebrospinal fluid (CSF) examination currently available. Areas covered: MRI of the total neuroaxis followed by CSF cytomorphology and flow cytometry are methods of choice when CNS lymphoma (CNSL) is suspected. To reduce the numerous pitfalls of these examinations several aspects should be considered. New CSF biomarkers might be of potential diagnostic value. Attempts to standardize response criteria are presented. Expert commentary: Diagnosing CNSL remains challenging. Until diagnostic methods combining high sensitivity with high specifity are routinely introduced, high level of awareness and optimal utilization of examinations currently available are needed to early diagnose this potentially devastating disease.
a Department of Hematology, Oncology and Tumor Immunology , Charite University Medicine Berlin , Berlin , Germany.
Agnieszka
A
Korfel
b Department of Neurology , Medical University Innsbruck , Innsbruck , Austria.
Martha
M
Nowosielski
c Department of Neurology , University Hospital King Juan Carlos , Madrid , Spain.
Javier
J
Pardo-Moreno
d Department of Hematology , University Hospital Foundation Alcorcón, Madrid , Spain.
Francisco Javier
FJ
Penalver
e Department of Hematology and Oncology , University of Pisa , Pisa , Italy.
Gabriele
G
Buda
f Department of Biology , Hôpital Foch , Suresnes , France.
Hind
H
Bennani
g Department of Biological Hematology , Pitie Salpetriere Hospital , Paris , France.
Myrto
M
Costopoulos
g Department of Biological Hematology , Pitie Salpetriere Hospital , Paris , France.
Magali
M
Le Garff-Tavernier
h Department of Hematology , Institut Curie - Hôpital René Huguenin , Paris , France.
Carole
C
Soussain
i Department of Hematology and Oncology , Stadtspital Triemli Zürich , Zürich , Switzerland.
Mathias
M
Schmid
j Department of Medicine and Cytometry Service , University of Salamanca , Salamanca , Spain.
Jose Alberto
JA
Orfao
k Penn State College of Medicine , Hershey , PA , USA.
Michael
M
Glantz
D015415:Biomarkers; D016543:Central Nervous System Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D003581:Cytodiagnosis / Q000379:methods; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D006801:Humans; D008223:Lymphoma / Q000473:pathology*; D064847:Multimodal Imaging / Q000379:methods; D017063:Outcome Assessment, Health Care; D010641:Phenotype; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D015415:Biomarkers
Secondary CNS lymphoma; cerebrospinal fluid cytomorphology; cerebrospinal fluid flow cytometry; meningeal; neuroaxis MRI; novel markers; parenchymal; response criteria