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CSF CYTOLOGY QUALITY IMPROVEMENT PROJECT
  1. Samer Dahdaleh,
  2. Alice Booker,
  3. Mimi Hou,
  4. Miguel A Perez–Machado
  1. Royal Free London Foundation NHS Trust

    Abstract

    Introduction CSF Cytology specificity and sensitivity is influenced by sample volume and time to fixation. A CSF volume of over 10 mls decreases the possibility of a false negative result and improves accuracy.1 2 The diagnostic sensitivity of the test is also dependant on being performed on patients with a reasonable clinical suspicion of malignancy/leptomeningeal involvement. CSF analysis remains the most definitive test for detecting leptomeningeal metastasis. We audited the results of lumbar punctures performed on neurology patients on the planned investigation unit between May and July 2012. This showed that cytology was performed routinely on every CSF sample collected. Over 96% of the samples contained less than 10 mls with over 90% of the samples containing less than 3 mls. There were no malignant cells detected in all samples. 2 of the 49 samples had no clinical information. The results were presented at the local neurology departmental meeting and several interventions were instituted with appropriate induction of the junior doctors involved in taking the samples. CSF Cytology was only performed if there was history of malignancy, meningeal enhancement on MRI, or if it was specifically requested by the neurologist who reviewed the patient in clinic. It was recommended that at least 10 mls of CSF was collected for cytology samples. The sample was to be taken immediately to the lab after collection with appropriate clinical information included. After the interventions, the audit was repeated.

    Methods Data of the results of all lumbar punctures performed on the planned investigation unit between October 2012 and January 2013 were reviewed. Data was obtained through cerner (an electronic health record system). Further clinical information was also obtained from letters, discharge summaries and notes. All cytology samples were processed in the same lab using a standardised method.

    Results 49 successful lumbar punctures were performed during the three month period. CSF Cytology was requested and processed on 8 patients CSF. 100% of the samples contained over 3 mls of CSF. 75% of the samples had a volume over 10 mls. No malignant cells were detected on all samples. All of the requests had appropriate clinical information on the request form except one which had no clinical information.

    Conclusion Our results showed a significant improvement in sample volume sent to the lab. Also there was a reduction in unnecessary cytology samples being sent. CSF Cytology sample processing takes 1 hour to process and costs around £70 per sample. This resulted in a reduction of cost from around £3430 per three month period (May to July 2012) to around £560 per three months (October 2012 to January 2013). Information regarding CSF cytology sample collection and requesting should be included as part of the induction of junior doctors.

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