The origin of brain metastases in patients with an undiagnosed primary tumour
Détails
ID Serval
serval:BIB_461DB65BB557
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
The origin of brain metastases in patients with an undiagnosed primary tumour
Périodique
Acta Neurochirurgica
ISSN
0001-6268 (Print)
Statut éditorial
Publié
Date de publication
02/2004
Volume
146
Numéro
2
Pages
153-7
Notes
Journal Article --- Old month value: Feb
Résumé
BACKGROUND: In patients presenting brain metastases as the first manifestation of a previously undiagnosed primary tumour (UDP) histopathological confirmation of the diagnosis can be obtained by either direct surgical sampling of the brain lesion or paraclinical search for an accessible primary tumour. The sequence of the diagnostic work-up and the timing of an eventual neurosurgical intervention are a matter of debate and are mainly influenced by the distribution of primary tumours in UDP patients. The aim of this study was to verify the hypothesis that the distribution of primary tumours differs between UDP patients and the rest of the patients with brain metastases (DP), and to propose a diagnostic work-up specifically tailored to the UDP population. METHODS: Retrospective study on 342 patients admitted to the Lausanne University hospital between 1983 and 1998 with the diagnosis of cerebral metastases. FINDINGS: UDP patients represented 36% of the whole group. Primary tumour location was significantly different between the two groups (p=0.001). Although the lung was the most frequent primary tumour location in both groups (UDP: 60%, DP: 43%), in UDP 14% only of the primaries were found outside of the lung and as much as 26% remained unknown despite thorough investigations. CONCLUSIONS: Our study confirmed the hypothesis that the relative frequency of primary tumours differs between DP and UDP patients. This difference therefore mandates a diagnostic strategy specifically tailored for UDP patients: if a radiological lung investigation clearly remains the best initial step in the work-up of these patients, extensive paraclinical investigations without a clear clinical suspicion should probably not be undertaken if this first survey fails to disclose the primary tumour as only 14% of the patients will actually benefit from it. In this situation, a neurosurgical procedure should probably be considered the most appropriate next step to be taken in order to provide a definitive diagnosis without unnecessary delays.
Mots-clé
Adult
Aged
Biopsy
Brain/pathology/surgery
Brain Neoplasms/diagnosis/pathology/*secondary/surgery
Diagnosis, Differential
Female
Humans
Karnofsky Performance Status
Logistic Models
Male
Neoplasms, Unknown Primary/*diagnosis/pathology/surgery
Neurologic Examination
Patient Discharge/statistics & numerical data
Retrospective Studies
Sensitivity and Specificity
Stereotaxic Techniques
Tomography, X-Ray Computed
Treatment Outcome
Pubmed
Web of science
Création de la notice
28/01/2008 9:31
Dernière modification de la notice
20/08/2019 14:51