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NEUROLOGY 2007;68:1674-1679
© 2007 American Academy of Neurology

CSF flow cytometry greatly improves diagnostic accuracy in CNS hematologic malignancies

J.E.C. Bromberg, MD, D. A. Breems, MD, PhD, J. Kraan, BSc, G. Bikker, B. van der Holt, MSc, P. Sillevis Smitt, MD, PhD, M. J. van den Bent, MD, M. van't Veer, MD, PhD and J. W. Gratama, MD, PhD

From the Departments of Neuro-Oncology (J.E.C.B., P.S.S., M.J.v.d.B.), Hematology (D.A.B., M.v.V.), Medical Oncology (J.K., J.W.G.), Clinical Chemistry (G.B.), and Trials and Statistics (B.v.d.H.), Erasmus MC–Daniel den Hoed Cancer Center, Rotterdam, the Netherlands.

Address correspondence and reprint requests to Dr. Jacoline E.C. Bromberg, Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Erasmus MC, University Medical Center Rotterdam, PO Box 5201, 3008 AE Rotterdam, the Netherlands j.bromberg{at}erasmusmc.nl

Objective: To assess the diagnostic accuracy of flow cytometric immunophenotyping in comparison with classic cytomorphology for diagnosing CNS localizations of hematologic malignancies, and to evaluate the implications of CSF pleocytosis and protein content in this context.

Methods: We reviewed the results of diagnostic evaluations of all CSF samples analyzed for localization of a hematologic malignancy between 2001 and 2004 at our center.

Results: A total of 1,054 samples from 219 patients were available for analysis. Sixty patients had a CSF localization diagnosed by positive flow cytometry, cytomorphology, or both. The first sample was positive by flow cytometry in 44 (73%) patients, by cytomorphology in 19 (32%). Four first samples were positive by cytomorphology but negative by flow cytometry. Patients with positive cytomorphology had more frequent clinical symptomatology (95% vs 58%) and CSF pleocytosis (84% vs 25%), and tended to a poorer progression-free survival than patients with positive flow cytometry only. OR for CNS localization in case of CSF pleocytosis was 10.1 (95% CI 4.9 to 20.8); OR for CNS localization in case of elevated protein content was 2.9 (95% CI 1.5 to 5.4). Nevertheless, 26 of 137 (19%) patients with normal cell count and protein concentration had a CNS localization.

Conclusions: The diagnostic value of flow cytometry is more than twice that of cytomorphology. However, cytomorphologic examination of the CSF has additional diagnostic and possibly prognostic value, and should still be performed in conjunction with flow cytometry.

Disclosure: The authors report no conflicts of interest.

Received July 21, 2006. Accepted in final form January 9, 2007.




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