Clinical Application Of Cerebrospinal Fluid Examination In Meningeal Metastasis

Background:Meningeal metastasis is a serious disease in which malignant tumors spreads from the original tumor site to the meninges through blood transfer,cerebrospinal fluid planting and dissemination,or adjacent tumors directly invade the meninges.It is a complication that mostly occurs in the late stage.The prognosis is generally poor with survival typically measured in months.The most common primary tumors are lung cancer,breast cancer,leukemia and lymphoma.Central nervous system leukemia,which is called CNL for short,is one special group of meningeal metastasis.The purpose of this study was to analyze the clinical application and significance of a series of cerebrospinal fluid examinations which included the cerebrospinal fluid cell count,the cerebrospinal fluid cytology,and the cerebrospinal fluid biochemical markers in the diagnosis of meningeal metastasis and CNL.Methods:A retrospective analysis of 341 patients taking a headache as the main complain admitted to hospital from Xiamen Zhongshan Hospital affiliated to Xiamen University from June 2010 to June 2018.The cerebrospinal fluid samples were taken at the same time for cerebrospinal fluid cell count by automated analyzer,cerebrospinal fluid cytology and cerebrospinal fluid biochemical indicators such as protein,lactate dehydrogenase,glucose,lactic acid and chlorine.The cases were divided into 5 groups:normal control group,meningeal metastasis group,CNL(Central nervous system leukemia)group,solid tumor group and headache group.Data were statistically analyzed using SPSS 20.0 software.The mean was compared by one-way variance,the positive rate was compared by chi-square test;and the diagnostic efficiency was analyzed by ROC curve.Results:1.The parameter HF-BF%(High-fluorescence body fluid cell percentage)was verified by precision.It is considered that the parameter is less than 20%sensitivity requirement of the instrument and is suitable for clinical application.2.The ROC curve was used to analyze the HF-BF%diagnostic threshold.The cutoff value of HF-BF%in meningeal metastasis group was 4.15%;the cutoff value of HF-BF%in CNL group was 3.75%.The mean value of HF-BF%in meningeal metastasis group was 81.17%,and the positive rate was 83,9%.The mean value of HF-BF%in the CNL group was 30.46%,and the positive rate was 63.4%.The mean and positive rate of HF-BF%in the CNL group were higher than those in the control group.The mean and positive rate of HF-BF%in the meningeal metastasis group were significantly higher than those in other groups(P<0.01).3.The glucose level of meningeal metastasis group was significantly lower than that of other groups(P<0.01);lactic acid and lactate dehydrogenase of meningeal metastasis group were significantly higher than other groups except solid tumor group(P<0.05).4.The combined diagnosis of HF-BF%and cerebrospinal fluid lactic acid can reduce the false positive rate of headache group from 45.8%to 12.2%.There is a significant difference between the two diagnostic patterns(P<0.01).Conclusion:1.HF-BF%can be used as a reliable indicator in clinical practice.HF-BF%has great value in the auxiliary diagnosis of meningeal metastasis,and it has certain reference significance in CNL,but the application value is not as significant as meningeal metastasis.2.The combined diagnosis of HF-BF%and cerebrospinal fluid lactic acid can effectively reduce the false positive rate of HF-BF%in non-cancerous meningitis.3.Cerebrospinal fluid cytology is still the most effective and reliable method for the diagnosis of meningeal metastasis and CNL.Our findings provided a new insight in clinical investigation of meningeal metastasis research,and open a new horizon in laboratory diagnosis.