Alireza Mansouri: Our multi-disciplinary, comprehensive review on CSF-based liquid biopsy in brain tumors
Alireza Mansouri, Neurosurgeon at
“Excited to share our multi-disciplinary, comprehensive review on CSF-based liquid biopsy in brain tumors, which allowed us to outline a potential roadmap to standardizing research done in this realm and optimize the integration of CSF analysis into routine clinical practice.
Why CSF?
- Cleaner than plasma = less noise
- Higher concentration of tumor specific markers
- May capture entire tumor landscape than tissue
CSF and plasma may be attractive screening tools in targeted populations with higher pre-test probability of CNS malignancy.
Does site of sampling matter? YES. While most studies looked at lumbar, we showed that many markers detected in ventricular samples may be missed in lumbar samples. This will impact limits of detection and therefore diagnostic cut-offs.
Through a meta-analysis of proteomics studies, we also identified individual biomarkers of malignancy in general, and those specific for gliomas, brain metastasis, and lymphomas along with pathways associated with each of these tumors.
Bringing all of this together, we put forth a proposed, integrated clinical-research pathway:
1) Currently, not enough evidence to systematically analyze CSF at time of diagnosis BUT collection of this sample category can be used for future validation studies.
2) In symptomatic patients, lumbar CSF may be more easily attainable and thus amenable to diagnostic biomarker studies.
3) We do advocate for implantation of CSF reservoirs to allow for longitudinal collection of CSF during therapy to monitor response and for early detection of relapse.
4) We strongly advocate for multi-omic analyses, as they provide complementary information.
5) Critical to characterize these biomarkers with clinical outcomes, cell-of-origin, and whether they represent malignancy or an artifact of blood-brain barrier breakdown.
6) Finally, large population prospective studies are needed to validate these markers.”
Source: Alireza Mansouri/X
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