van de Pol M, van Aalst V C, Wilmink J T, Twijnstra A
Department of Neurology, University Hospital Maastricht, The Netherlands.
J Neurol Neurosurg Psychiatry. 1996 Sep;61(3):321-3. doi: 10.1136/jnnp.61.3.321.
Seventy two patients presenting with symptomatic brain metastases from undiagnosed primary neoplasms were retrospectively reviewed. Primary malignancies were diagnosed before death in 54 patients and remained unknown in 18 patients. Lung cancer was the most common primary tumour (72%), followed by breast cancer, colon carcinoma, and melanoma. On physical examination, 51 patients had organ specific symptoms or signs providing guidelines to the diagnostic evaluation. In 24 of the 52 patients with a primary lung tumour, and in four of the 20 patients without, organ specific complaints or findings suggested this tumour type, resulting in a positive predictive value of 85%. Overall, radiography and CT of the chest were very useful in detection of primary lung tumours. This could partly be explained by the high prior probability of detecting such tumours. Other diagnostic procedures should be used on indication only. The prognosis of patients with confirmed primary tumour position did not differ from those with unidentified primary tumour.
对72例表现为未确诊原发性肿瘤所致症状性脑转移的患者进行了回顾性研究。54例患者在死亡前确诊了原发性恶性肿瘤，18例患者仍未明确。肺癌是最常见的原发性肿瘤（72%），其次是乳腺癌、结肠癌和黑色素瘤。体格检查时，51例患者有器官特异性症状或体征，为诊断评估提供了线索。在52例原发性肺癌患者中的24例，以及20例非原发性肺癌患者中的4例，器官特异性主诉或检查结果提示了这种肿瘤类型，阳性预测值为85%。总体而言，胸部X线和CT对原发性肺癌的检测非常有用。这部分可以通过检测此类肿瘤的高先验概率来解释。其他诊断程序应仅根据指征使用。确诊原发性肿瘤部位的患者预后与未明确原发性肿瘤的患者无异。
