Mavrakis A N, Halpern E F, Barker F G, Gonzalez R G, Henson J W
Stephen E. and Catherine Pappas Center for Neuro-oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
Neurology. 2005 Sep 27;65(6):908-11. doi: 10.1212/01.wnl.0000176059.21455.76.
Patients with a newly detected brain mass and no history of cancer often undergo extensive diagnostic testing in search of a systemic primary neoplasm prior to selection of a biopsy site, potentially leading to unnecessary expense and delay. We sought patterns in the evaluation of these patients to allow rapid selection of a biopsy site.
We compared the diagnostic evaluation of 176 patients with newly detected brain masses who were ultimately determined to have a metastatic or primary lesion.
In 88 patients presenting with brain metastasis, lung cancer was markedly overrepresented as a primary tumor, occurring in 82% of patients. Brain MRI and chest CT together identified the site for diagnostic biopsy in all except for two of the 176 patients. One-half of the patients with metastasis had brain biopsy as the primary diagnostic procedure, with 80% undergoing a craniotomy rather than needle biopsy. The initial management decision in the majority of metastasis patients was whether to perform a craniotomy for resection of tumor. Whereas patients with single and cerebellar lesions were most likely to undergo craniotomy, the extent of systemic disease did not affect the decision to recommend a neurosurgical procedure. The average time to biopsy for patients with metastatic and primary tumors was 4.7 days and 6.0 days. In this retrospective population, we estimated that evaluation with brain MRI and chest CT, followed by an early neurosurgical decision, could reduce the time to diagnosis by at least 10%.
Chest CT and brain MRI, if used together as initial diagnostic studies, would have identified a biopsy site in 97% of patients with a newly detected brain mass.
新发现脑部肿块且无癌症病史的患者在选择活检部位之前，通常会接受广泛的诊断检查以寻找全身性原发性肿瘤，这可能导致不必要的费用和延误。我们探寻这些患者评估中的模式，以便快速选择活检部位。
我们比较了176例新发现脑部肿块最终被确定为有转移或原发性病变患者的诊断评估情况。
在88例出现脑转移的患者中，肺癌作为原发性肿瘤明显占比过高，82%的患者出现该情况。脑部MRI和胸部CT一起确定了176例患者中除2例之外所有患者的诊断活检部位。一半的转移患者将脑活检作为主要诊断程序，其中80%接受开颅手术而非穿刺活检。大多数转移患者的初始治疗决策是是否进行开颅手术切除肿瘤。单发病变和小脑病变的患者最有可能接受开颅手术，而全身性疾病的程度并不影响推荐神经外科手术的决策。转移瘤和原发性肿瘤患者进行活检的平均时间分别为4.7天和6.0天。在这个回顾性研究人群中，我们估计通过脑部MRI和胸部CT评估，然后尽早做出神经外科决策，可以将诊断时间至少缩短10%。
如果将胸部CT和脑部MRI一起用作初始诊断研究，97%新发现脑部肿块的患者可以确定活检部位。
