Leptomeningeal metastases in the MRI era

Neurology (Impact Factor: 8.29). 01/2011; 76(2):200; author reply 200-1. DOI: 10.1212/WNL.0b013e3181fac738
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    • "CNS signs and symptoms, indicative of LM in more than 90% of patients, may be pleomorphic and are often subtle and difficult to distinguish from other cancer or antineoplastic treatment complications [10]. The specificity of gadolinium-enhanced MRI signs is up to 100% in solid tumors, balanced by a risk of false negative as high as 65% and false positive approaching 10% [11]. Evidence of malignant cells in the CSF is diagnostic of LM. "
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    ABSTRACT: Background The diagnosis of leptomeningeal metastasis (LM) in patients with solid tumors remains difficult. The usual diagnostic methods of cytomorphological assessment of cerebro-spinal fluid (CSF) and gadolinium enhanced MRI of the entire neuraxis lack both specificity and sensitivity. The Veridex CellSearch® technology has been designed for the detection of circulating tumor cells (CTC) in blood from cancer patients and validated for the follow-up and prognosis of breast, prostate, colorectal, and lung cancer. Our aim was to adapt this technology for the detection and the enumeration of tumor cells in the CSF of breast cancer patients presenting with LM. Methods On the occasion of a randomized phase III study evaluating the role of the intrathecal treatment in LM from breast cancer (DEPOSEIN, EudraCT N°: 2010-023134-23), the CellSearch® technology was adapted to direct enrichment, enumeration and visualization of tumor cells in 5 mL CSF samples, collected on CellSave® Preservative Tubes and analyzed within 3 days after CSF sampling. Results Sixteen CSF of 8 patients with primary breast cancer presenting with LM were studied. EpCAM+/cytokeratin + cells with typical morphology could be observed and enumerated sequentially with reproducible results in low or elevated numbers in 8 patients. Conclusion This methodology, established on a limited volume of sample and allowing delayed processing, could prove of great interest in the diagnosis and follow-up of cancer patients with LM, especially to appreciate the efficacy of chemotherapy.
    BMC Clinical Pathology 11/2012; 12(1):21. DOI:10.1186/1472-6890-12-21
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    • "Palma et al. / Clinical Neurology and Neurosurgery xxx (2012) xxx– xxx showed that patients with LC detected by MRI had a significantly increased CSF protein level. This result, in addition to the fact that increased CSF protein level is a predictive marker for unfavorable prognosis, suggests that LC detected by MRI might be a surrogate marker for advanced brain–blood barrier disruption (leading to an increased CSF protein level due to a passage of both serum proteins into the CSF and tumor and white blood cells breakdown directly related to leptomeningeal inflammation [28]), rather than a suitable method for diagnosis of early stages of leptomeningeal disease, as previous works have suggested [20] [29] [30]. However, an attractive investigation to be performed in further studies might be the analysis of diagnostic accuracy of LC diagnosis using 1.5 T MRI compared to 3 T MRI. "
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    ABSTRACT: INTRODUCTION: Leptomeningeal carcinomatosis (LC) is a devastating complication occurring in 5% of all patients with cancer. To date there are no well-established prognostic markers in patients with LC, except for the presence of cerebrospinal fluid (CSF) blocks and the Karnofsky performance status scale (KPS). We aimed to identify clinical, neuroradiologic and CSF prognostic factors related to LC survival and to develop an easy-to-use Prognostic Scoring Scale (PSS) to identify patients who are more likely to benefit from receiving treatment. METHODS: Single-center retrospective study evaluating patients who had a diagnosis of LC during a 10-year period. Diagnosis was made by malignant cytology or imaging; suspicious cases treated as LC were also included. RESULTS: Fifty patients with LC were analyzed (58% women). Median age was 54.4 years, and KPS was 60%. The most common types of tumor were breast (35%), lung (24%), and hematologic malignancies (16%). Thirty-two percent of patients were diagnosed by imaging, 22% by cytology, and 40% by both. Median overall survival (OS) was 10 weeks (95% confidence interval 5.1-14.9). Median OS for patients who received specific treatment was 21.2 weeks vs. 6.38 weeks for patients receiving supportive care only (p<0.001). In multivariate analysis, initial KPS, initial CSF protein level (<112mg/dL) and time from diagnosis of primary tumor to diagnosis of LC (>67 weeks) were significant and independent predictors of increased survival. CONCLUSIONS: Prognosis remains poor in LC. The predictive factors for patients with LC here identified could help to improve the selection of patients who are more likely to benefit from receiving treatment.
    Clinical neurology and neurosurgery 04/2012; 115(1). DOI:10.1016/j.clineuro.2012.03.048 · 1.13 Impact Factor
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    ABSTRACT: We report a 76-year-old caucasian man who presented with a 3-week history of progressive confusion. His past medical history included a left nephro-uretectomy for poorly differentiated transitional cell carcinoma 9 years previously. Besides his confusion, his clinical and neurological examination was unremarkable. Extensive investigation revealed only isolated hypoglycorrachia and mildly elevated CSF protein. Cerebral CT and MRI scans without contrast did not reveal any abnormalities. As his condition continued to decline, an MRI scan of the brain with gadolinium was performed which revealed extensive nodular enhancement of the surface of the cerebellum and brainstem and both temporal lobe convexities. Repeat lumbar puncture showed malignant cells in the CSF and confirmed the diagnosis of leptomeningeal carcinomatosis. This case illustrates that leptomeningeal carcinomatosis should be considered in the differential diagnosis of cognitive decline in the elderly, after other common aetiologies have been excluded. The index of suspicion should be increased in patients with a prior history of cancer.
    Journal of Clinical Neuroscience 10/2005; 12(7):841-3. DOI:10.1016/j.jocn.2004.11.007 · 1.38 Impact Factor
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