Importance of evaluating cerebrospinal fluid at vitreoretinal lymphoma diagnosis
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Rebecca Silverman, MD, and associates advised evaluating the cerebrospinal fluid (CSF) in patients suspected of having vitreoretinal lymphoma to ensure that vitreoretinal lymphoma is not missed.1 She is from the Department of Surgery, Memorial Sloan Kettering Cancer Center, and the Department of Ophthalmology, Weill Cornell Medical College, both in New York.
The research group undertook a retrospective, single-center, observational study with the goal of determining if patients with vitreoretinal lymphoma and concomitant central nervous system (CNS) lymphoma can present without positive findings of lymphoma on magnetic resonance imaging (MRI) but have CSF findings that are suspicious for lymphoma.
The study identified patients who were diagnosed with or were suspected of having vitreoretinal lymphoma at Memorial Sloan Kettering Cancer Center between 2006 and 2024.
The inclusion criteria were a diagnosis of CNS lymphoma confirmed by biopsy and MRI brain scans with/without contrast ±CSF evaluation (obligatory for inclusion if the MRI brain images were negative) performed at the initial diagnostic workup. Patients who had had previous extra-CNS disease were included, the authors explained.
The exclusion criterion was treatment for CNS disease that occurred before the development of ocular disease.
The researchers evaluated the proportion of patients with negative MRI brain scans and with CSF suspicious for lymphoma. The subgroup analysis included imaging features, pathology, treatment, and disease course.
Analysis results
Sixty-five patients were included in the study.
The following is a breakdown of the findings at vitreoretinal lymphoma presentation: 30 patients had negative MRI brain images and negative CSF results, 16 had positive MRI brain images and negative CSF results, 8 had positive MRI brain images and positive CSF results, and 11 (16.9%) had CSF suspicious for lymphoma without positive MRI brain images.
In the last subgroup, the median patient age was 66 years (range, 49–82) and 36% were female.
The investigators found that 86% of these patients were asymptomatic neurologically; 73% of them underwent systemic treatment. At a mean 3 years follow-up, 91% of patients remained alive.
The investigators concluded that in patients with suspected vitreoretinal lymphoma, they can have CSF that tests positive for lymphoma in the presence of negative MRI brain scans. “This suggests that when evaluating patients with vitreoretinal lymphoma for concomitant CNS disease, CSF evaluation leads to earlier detection and systemic treatment, even when MRI brain findings are negative. In our cohort, an absence of CSF evaluation in the context of negative brain MRI could have missed 16.9% of patients with CNS lymphoma,” Dr. Silverman and colleagues concluded.
