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Vol. 43. Issue 7.
Pages 386-391 (January 2007)
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Vol. 43. Issue 7.
Pages 386-391 (January 2007)
Original Articles
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Silent Brain Metastasis in the Initial Staging of Lung Cancer: Evaluation by Computed Tomography and Magnetic Resonance Imaging
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Julio Sánchez de Cos Escuína,
Corresponding author
jsd01cc@saludalia.com

Correspondence: Dr. J. Sánchez de Cos Escuín. Isla de Hierro, 2, 3.°C. 10001 Cáceres. España
, Diego Masjoans Mennab, M. Agustín Sojo Gonzáleza, José Zamorano Quirantesc, Carlos Disdier Vicentea, María Cristina Pérez Calvod
a Sección de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
b Unidad de Resonancia Magnética, Clínica San Francisco, Cáceres, Spain
c Unidad de Investigación Clínica, Hospital San Pedro de Alcántara, Cáceres, Spain
d Servicio de Radiología, Hospital San Pedro de Alcántara, Cáceres, Spain
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OBJECTIVE

Brain metastases are common in patients with lung cancer and influence both prognosis and treatment decisions. The aim of this study was to evaluate the incidence of silent brain metastasis during the initial staging of lung cancer using cranial computed tomography (CT) and magnetic resonance imaging (MRI).

PATIENTS AND METHODS

We performed a retrospective analysis of lung cancer patients with no neurologic signs or symptoms who were evaluated by cranial CT, MRI, or both at the time of diagnosis. Results were checked using data obtained during systematic monitoring of progression. The incidence of brain metastasis was analyzed by sex, age, histology, and TNM stage.

RESULTS

Silent brain metastasis was detected in 8.3% of the 169 patients with lung cancer. The detection rate was 7.9% in the cranial CT group and 11.3% in the cranial MRI group. The percentage of false positives and false negatives was 0% and 1.9%, respectively. Cranial MRI performed better than CT in detecting multiple brain metastases (72.8% vs 50%) and metastases smaller than 1 cm (36.3% vs 16.7%). The incidence of brain metastasis was lower in patients aged over 70 years and higher in patients with adenocarcinoma (20% compared to 5.3% to 5.9% for other histologic subtypes, P=.01). No association was found with TNM stage.

CONCLUSIONS

The incidence of silent brain metastasis is high in patients under 70 years of age, particularly in patients with adenocarcinomas, even in initial stages. This should be taken into consideration when planning staging procedures. Cranial MRI seems to be more accurate than cranial CT for detecting multiple metastases and small metastases.

Key words:
Lung cancer
Silent brain metastasis
Computed tomography
Magnetic resonance imaging
OBJETIVO

Las metástasis cerebrales (MC) son frecuentes en el cáncer de pulmón (CP) y tienen influencia pronóstica y terapéutica. El objetivo del trabajo ha sido evaluar la incidencia de MC silentes en la estadificación inicial del CP mediante tomografía axial computarizada y resonancia magnética craneales (TACC y RMC).

PACIENTES Y MÉTODOS

Análisis retrospectivo de los pacientes con CP que tenían un estudio craneal mediante TACC y/o RMC en ausencia de síntomas/signos neurológicos en el momento del diagnóstico. Para verificar los resultados se usó como criterio la evolución mediante un seguimiento frecuente. Se comparó la incidencia de MC según sexo, edad, histología y estadio TNM.

RESULTADOS

Se detectaron MC silentes en el 8,3% de 169 pacientes con CP: un 7,9% en el grupo de TACC y un 11,3%, en el de RMC. La tasa de resultados falsos positivos fue del 0% y la de falsos negativos, del 1,9%. La RMC detectó más MC múltiples (un 72,8 frente a un 50%) y menores de 1 cm (un 36,3 frente a un 16,7%) que la TACC. La incidencia de MC fue menor en mayores de 70 años y superior en adenocarcinomas (un 20 frente a un 5,3–5,9%; p = 0,01). No hubo relación con el grado de extensión.

CONCLUSIONES

En pacientes menores de 70 años y espe cialmente en adenocarcinomas, la incidencia de MC silentes es elevada, incluso en estadios iniciales, lo que debería considerarse al planificar las pruebas de estadificación. La RMC parece más exacta para detectar MC múltiples y de pequeño tamaño.

Palabras clave:
Cáncer de pulmón
Metástasis cerebrales silentes
Tomografía computarizada
Resonancia magnética
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Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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