Patients diagnosed with lymphoid neoplasia can suffer central nervous system dissemination (CNS-D). Cerebrospinal fluid (CSF) cytometry is currently the gold-standard laboratory test but is not widely available in low-income countries and primary care hospitals. Progression of neurological deficits occurs in absence of timely diagnosis and treatment with intrathecal chemotherapy. In consequence, it is necessary to identify variables associated with this condition for better profiling patients at risk.
Cases of adult patients with suspected dissemination of lymphoid neoplasia to the CNS were analyzed. Clinical and paraclinical variables were evaluated through a multivariate logistic regression defining a positive result on CSF flow cytometry as the outcome. Sensitivity and specificity were calculated for features with a significant association.
101 patients with a median age of 47 years (34-64) and diagnosed with lymphoid neoplasia (59.4% lymphoma) were included. 35 (34.31%) patients had positive results on CSF flow cytometry for neoplastic dissemination (62.86% men). CSF cytochemical analysis in patients with confirmed CNS-D showed pleocytosis (72 cells/mm3, 8-166) and elevated concentrations of proteins (62.5 mg/dL, 41-94.2) and LDH (36 U/L, 22-48). In the logistic regression, hyperproteinorrhachia was independently associated with confirmed CNS-D and exhibited a sensitivity of 100% and a specificity of 63%. On the other hand, LDH demonstrated a sensitivity of 60% and a specificity of 93%.
In this sample, the results of the CSF cytochemical analysis were associated with CNS-D. The combination of hyperproteinorrachia (high sensitivity) and elevated LDH concentration (high specificity) could initially guide the suspicion in settings where flow cytometry is not available.