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The sensitivity of CSF cytology is low (2%-32%) but increases when combined with cytometry. Cerebrospinal fluid lactate dehydrogenase isozyme 5, ?2- macroglobulin, and immunoglobulin heavy chain rearrangement studies have improved sensitivity over CSF cytology (58%-85%) but have only moderate specificity 85%. New techniques of proteomics and microRNA analysis have more than 95% specificity in the diagnosis of CNS lymphoma. Positive CSF cytology, vitreous biopsy, or brain/leptomeningeal biopsy remain the current standard for diagnosis. A combined stepwise systematic approach outlined here may facilitate an expeditious, comprehensive presurgical evaluation for cases of suspected CNS lymphoma. |
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bone marrow biopsy
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