Jack Megan M, Smith Brandon W, Capek Stepan, Marek Tomas, Carter Jodi M, Broski Stephen M, Amrami Kimberly K, Spinner Robert J
1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
J Neurosurg. 2022 Feb 25;137(5):1368-1377. doi: 10.3171/2021.12.JNS211882. Print 2022 Nov 1.
Perineural spread of breast cancer to the brachial plexus can lead to pain, sensory alterations, and upper-extremity weakness. Although rare, perineural spread is an often-misdiagnosed long-term complication following breast cancer diagnosis. The objective of this study was to critically review the clinical, radiological, and pathological findings of biopsy-proven perineural spread of breast cancer to the brachial plexus.
This is a retrospective study from a single institution in which a total of 19 patients with brachial plexus involvement from perineural spread of breast cancer who underwent fascicular biopsy between 1999 and 2021 were identified. Clinical, radiographic, and pathological data were retrospectively collected. Descriptive statistics were calculated for the cohort.
The mean age of patients at the time of diagnosis of breast cancer perineural spread was 60.6 ± 11.5 years. The diagnosis of brachial plexopathy due to perineural spread was on average 12 years after the primary diagnosis of breast cancer. There was also a delay in diagnosis due to the rarity of this disease, with a mean time from initial symptom onset to diagnosis of perineural spread of 25 ± 30 months. All patients at the time of presentation had upper-extremity weakness and pain. Nearly all patients demonstrated T2 signal change and nodular so-called sugar-coating contrast enhancement on brachial plexus MRI. Similarly, all patients who underwent PET/MRI or PET/CT had increased FDG uptake in the involved brachial plexus. Breast cancer perineural spread has an overall poor prognosis, with 16 of 19 patients dying within 5.9 ± 3.0 years after diagnosis of perineural spread.
Perineural spread should be considered in patients with a history of breast cancer, even 10 years after primary diagnosis, especially in patients who present with arm pain, weakness, and/or sensory changes. Further diagnostic workup with electrodiagnostic studies; brachial plexus MRI, PET/CT, or PET/MRI; and possibly nerve biopsy is warranted to ensure accurate diagnosis.
乳腺癌向臂丛神经的神经周围扩散可导致疼痛、感觉改变和上肢无力。尽管罕见，但神经周围扩散是乳腺癌诊断后一种常被误诊的长期并发症。本研究的目的是严格审查经活检证实的乳腺癌向臂丛神经神经周围扩散的临床、放射学和病理学表现。
这是一项来自单一机构的回顾性研究，共确定了19例因乳腺癌神经周围扩散累及臂丛神经且在1999年至2021年间接受束状活检的患者。回顾性收集临床、影像学和病理学数据。计算该队列的描述性统计数据。
乳腺癌神经周围扩散诊断时患者的平均年龄为60.6±11.5岁。因神经周围扩散导致的臂丛神经病变诊断平均在乳腺癌初次诊断后12年。由于这种疾病罕见，诊断也存在延迟，从最初症状出现到神经周围扩散诊断的平均时间为25±30个月。所有患者就诊时均有上肢无力和疼痛。几乎所有患者在臂丛神经MRI上均表现为T2信号改变和结节状所谓的“糖衣”对比增强。同样，所有接受PET/MRI或PET/CT检查的患者在受累臂丛神经中FDG摄取增加。乳腺癌神经周围扩散总体预后较差，19例患者中有16例在神经周围扩散诊断后5.9±3.0年内死亡。
有乳腺癌病史的患者，即使在初次诊断后10年，尤其是出现手臂疼痛、无力和/或感觉改变的患者，应考虑神经周围扩散。有必要进行进一步的诊断检查，包括电诊断研究、臂丛神经MRI、PET/CT或PET/MRI，可能还需要进行神经活检以确保准确诊断。
