Bone‐marrow micrometastases in patients with brain metastases from epithelial cell tumours

Carcinoma that has metastasized to the central nervous system (CNS) poses a particular clinical problem regarding confirmation of the diagnosis and subsequent management. Prior to excision, thorough evaluation for coexisting systemic disease is essential, but current imaging techniques are limited b...

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Bibliographic Details
Published in:QJM : An International Journal of Medicine 2000-09, Vol.93 (9), p.611-615
Main Authors: Maguire, D., O'Sullivan, G.C., McNamara, B., Collins, J.K., Shanahan, F.
Format: Article
Language:English
Subjects:
Adenocarcinoma - diagnosis
Adenocarcinoma - secondary
Biological and medical sciences
Biomarkers, Tumor - analysis
Bone Marrow Examination - methods
Bone Marrow Neoplasms - diagnosis
Bone Marrow Neoplasms - secondary
Brain - diagnostic imaging
Brain Neoplasms - diagnosis
Brain Neoplasms - secondary
Breast Neoplasms - pathology
Carcinoma - diagnosis
Carcinoma - secondary
Carcinoma, Ductal, Breast - diagnosis
Carcinoma, Ductal, Breast - secondary
Female
Flow Cytometry
Gastrointestinal Neoplasms - pathology
Humans
Immunohistochemistry
Keratins - analysis
Medical sciences
Neoplasm Staging
Neurology
Predictive Value of Tests
Prospective Studies
Tomography, X-Ray Computed
Tumors of the nervous system. Phacomatoses
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Summary:Carcinoma that has metastasized to the central nervous system (CNS) poses a particular clinical problem regarding confirmation of the diagnosis and subsequent management. Prior to excision, thorough evaluation for coexisting systemic disease is essential, but current imaging techniques are limited by their spatial resolution and under‐stage many patients. We evaluated the potential utility of bone‐marrow evaluation for micrometastatic cells in patients with CNS metastasis. Bone‐marrow aspirates were examined for cytokeratin‐positive cells in 12 consecutive patients who presented with symptomatic space‐occupying lesions of the CNS. These patients had previously undergone surgical excision of either gastrointestinal or breast cancers. All twelve had micrometastases in their bone marrow at the time of presentation with the CNS disease and all had a fatal outcome within 13 months. In nine of the 12 patients, bone‐marrow micrometastases were the only evidence for systemic spread. Three patients had elevated serum tumour markers and two of these had radiologically detectable recurrence elsewhere. Bone‐marrow micrometastases indicate concurrent systemic involvement and a poor prognosis. The results suggest that bone‐marrow evaluation for systemic spread is a useful diagnostic adjunct and should be performed before considering diagnostic biopsy or excision.
ISSN:1460-2725
1460-2393
DOI:10.1093/qjmed/93.9.611