Materiały źródłowe

• #1 Review of Current Principles of the Diagnosis and Management of Brain Metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9171239/

  Brain metastases are the most common intracranial tumors and are increasing in incidence as overall cancer survival improves. Diagnosis of brain metastases involves both clinical examination and magnetic resonance imaging. […] The most common presenting signs and symptoms of brain metastases are those associated with any intracranial mass lesion, including headache, nausea, vomiting, focal neurologic deficits, seizure, and, in severe cases, disorders of consciousness. Prompt acquisition of cranial imaging is indicated. In an acute setting, computed tomography (CT) imaging can often be acquired more rapidly and may demonstrate the presence of a mass lesion, the extent of edema and mass effect on brain parenchyma, and the presence of tumor-associated hemorrhage. However, magnetic resonance imaging (MRI) is the gold standard diagnostic imaging modality in the evaluation of brain metastases.

• #2 Brain Metastasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470246/

  Brain metastases are a common complication of cancer and the most common type of brain tumor. Anywhere from 10% to 26% of patients who die from their cancer will develop brain metastases. […] This activity reviews the presentation of brain metastases and highlights the role of the interprofessional team in its management. […] Review the evaluation of a patient with brain metastases. […] A head computed tomography (CT) allows for a quick examination. However, fine-slice MR of the brain with contrast is the gold standard for neuroimaging in cases of suspected brain metastases. […] The first step in the management of newly diagnosed brain metastases is the treatment of intracranial edema. […] Following the initiation of steroids, definitive management may be initiated. Treatment options include surgical resection, whole-brain radiotherapy, and stereotactic radiosurgery.

• #2 Brain Metastases | Cancer Spread to Brain | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/advanced-cancer/brain-metastases.html

  Brain metastases develop most often in people with lung cancer, breast cancer, and melanoma, but also with other types of cancer. […] Brain metastases are usually single spots, but some types of cancer can cause meningitis (swelling of the linings of the brain). […] Symptoms of brain metastases depend on the location, size and number of growths in the brain, or the amount of swelling. […] Steroid medicines, such as dexamethasone, are often used to reduce swelling in the brain around the metastases. […] Radiation therapy is often used to manage brain metastases and control symptoms. […] Surgery is also sometimes used to treat brain metastases, especially if there are no more than three spots. […] Chemotherapy is not usually a treatment for brain metastases because these medicines have a hard time getting into the brain.

• #3 Epidemiology, clinical manifestations, and diagnosis of brain metastases – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-brain-metastases

  Epidemiology, clinical manifestations, and diagnosis of brain metastases […] Brain metastases are the most common intracranial tumors in adults, accounting for significantly more than one-half of brain tumors. In patients with systemic malignancies, brain metastases occur in 10 to 30 percent of adults and 6 to 10 percent of children. […] The etiology, clinical manifestations, and diagnosis of brain metastases will be reviewed here, along with an overview of the approach to treatment. […] DIAGNOSIS […] Imaging studies […] Biopsy […] Unknown primary tumor […] Number of metastases

• #3 Review of Current Principles of the Diagnosis and Management of Brain Metastases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9171239/

  In patients with a symptomatic intracranial lesion and a known diagnosis of a primary cancer originating from outside the central nervous system, these imaging findings are highly suggestive of a diagnosis of brain metastasis; however, in patients without a history of cancer, a solitary brain mass is unlikely to be a metastatic lesion and is more probably a primary brain tumor. The presence of multiple lesions, especially when involving multiple intracranial compartments, is effectively diagnostic of metastasis. […] With improved survival associated with advances in systemic oncologic therapies and increasing accessibility of advanced imaging, some brain metastases are diagnosed incidentally on imaging obtained for unrelated indications. Routine screening imaging of the brain is not necessary in patients with systemic cancer without neurologic symptoms.

• #4 Brain Metastasis from Lung Cancer | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/symptoms-diagnosis/lung-cancer-staging/brain-metastasis

  Determining if lung cancer has spread is part of the staging process. It is common for lung cancer to spread to the brain, often called brain metastasis or brain mets. […] Brain metastases (sometimes called brain mets) occur when cancer cells spread from their original site, in this case the lung, to the brain. […] How are brain metastases diagnosed? Usually, brain mets are first diagnosed using an MRI with contrast. During an MRI with contrast, dye is injected into your arm which makes the image of the brain clearer. […] If a lung cancer patient doesn’t have brain mets at first diagnosis, there is no clear guidance about how often a patient should receive an MRI to check for brain mets. However, for patients with stage four disease, most physicians will perform a yearly brain MRI. […] What are the symptoms of brain metastasis? Sometimes brain mets dont cause any symptoms. Symptoms can either be focal (related to the specific part of the brain where there is a nodule) or they can be global (interfere with the general function of the brain).

• #5 Brain Metastasis from Lung Cancer | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/symptoms-diagnosis/lung-cancer-staging/brain-metastasis

  How common are brain metastases in lung cancer patients? Generally, brain metastases in lung cancer patients are very common. It does vary by the type of lung cancer you have or the specific biomarkers found in the cancer cells. Among patients with lung cancer, about 16 to 20 percent develop brain metastases. […] Leptomeningeal disease (LMD) is usually diagnosed by lumbar puncture where a sample is taken from the fluid between two vertebrae in the lumbar (lower) part of the spine. […] What is the logic behind the different types of scans for brain metastases? PET scans are not recommended for diagnosing or monitoring brain scans because the brain is very active and it makes the PET scan light up, even if there are no tumors. […] Physicians have a choice between using a CT scan with contrast or an MRI with contrast. An MRI with contrast is preferred because it is a more sensitive test which can pick up smaller deposits in the brain.

• #6 Brain metastases – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140

  Tests and procedures for diagnosing brain metastases include: […] Your healthcare professional checks your cognition, speech, vision, hearing, balance, coordination, strength, sensation and reflexes. […] Magnetic resonance imaging, also called MRI, is the main test used to help show the location and size of brain metastases. […] Your healthcare professional may recommend a procedure to remove a sample of tissue for testing in a lab. […] Surgery may help improve symptoms and help with diagnosis. […] Healthcare professionals have made major advances understanding whole-brain radiation and stereotactic radiosurgery. […] In deciding which radiation therapy to have, you and your healthcare professional will consider many factors. […] If you’re diagnosed with brain metastases, you’ll be referred to one or more of the following healthcare professionals: A neuro-oncologist, who specializes in brain metastases.

• #7 Brain Metastases: When Cancer Spreads to the Brain

  https://my.clevelandclinic.org/health/diseases/17225-metastatic-brain-tumors

  Brain metastases are a type of metastatic cancer. They occur when a malignant tumor in one part of your body spreads to your brain. […] Your healthcare provider will perform tests if you have cancer and you’re experiencing symptoms of a brain tumor. Even if you don’t have symptoms, your provider may screen you for brain metastases if you have a primary cancer that’s likely to spread. […] Tests include: Neurological exam. During a neurological exam, your provider will look for changes in your balance, coordination, mental status, hearing, vision and reflexes. These changes can point to the part of your brain that the tumor is affecting. […] Your healthcare provider may begin by treating your immediate symptoms with medicine. […] Treatment for metastatic brain tumors aims to stop or slow the tumors growth in your brain while reducing your symptoms.

• #8 Symptoms and Diagnosis of Brain Metastases – Brainlab.org

  https://www.brainlab.org/get-educated/brain-metastasis/investigate-brain-metastasis/symptoms-and-diagnosis-of-brain-metastases/

  If you have these or other symptoms, discuss them with your doctor in the context of your primary cancer, overall health and medical history. In-office tests may be done, including assessment of reflexes, cognition (thinking / thought processing), sensations, muscle strength, alertness, etc. If these assessments require more testing, your neuro-oncologist or neurosurgeon may then send you for diagnostic imaging of the brain and additional parts of the body to figure out whether the primary cancer has spread elsewhere. […] There are different scans that may be needed and a patient may need more than one scan to diagnose the tumor size and location and type. A few different types of scans and imaging techniques may be used to diagnose metastatic brain tumors. […] Most Common Imaging Techniques

• #9 Brain Metastases – AIM at Melanoma Foundation

  https://www.aimatmelanoma.org/stages-of-melanoma/brain-metastases/

  Brain metastases, a specific form of Stage IV melanoma, are one of the most common and difficult-to-treat complications of melanoma. Brain metastases differ from all other metastases in terms of risk factors, diagnosis, and treatment. […] If your doctor suspects that your melanoma has spread to your brain, he or she may recommend a number of tests and procedures. […] A neurological exam may include, among other things, checking your vision, hearing, balance, coordination, strength, and reflexes. […] Imaging tests. Magnetic resonance imaging (MRI) is commonly used to help diagnose brain metastases. […] If a suspicious lesion is found but the diagnosis is uncertain, a biopsy may be performed to obtain a tissue sample for evaluation. […] The treatment options for brain metastases are determined by the number of metastases, their size and location, the presence of extracranial metastases, any prior treatment for melanoma, whether your melanoma is known to have a BRAF mutation, and your performance status.

• #10 Diagnosis of Metastatic Brain Cancer | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/brain-tumors-metastatic/diagnosis

  Experts, such as neuroradiologist Robert Young, evaluate brain tumors that have spread from other parts of the body. […] To diagnose brain metastases, your doctor often will: […] Give you imaging tests. […] During a CT scan, a special machine uses X-rays to take a fast series of pictures from many angles. The X-ray pictures are put together to make 3D images of the brain. These images can show problems, such as tumors in the brain. […] An MRI is a test that uses strong magnetic fields to take pictures. It lets us see very detailed images of brain tissue and find small tumors that CT scans may miss. […] Our doctors use advanced imaging tests, such as CT scans, MRIs, and PET scans, to help detect and diagnose disease, make appropriate treatment recommendations, and monitor your response to therapy.

• #11 Diagnosis and management of brain metastases: an updated review from a radiation oncology perspective

  https://www.oaepublish.com/articles/2394-4722.2019.20

  Brain metastasis are the most common intracranial malignancy in the adult population. […] Diagnosis is made using different imaging approaches, such as computed tomography and magnetic resonance imaging, accompanied by clinical manifestations and a history of malignancy supporting the diagnosis of a brain metastasis. […] Magnetic resonance imaging (MRI) is the tool of choice when brain metastasis is suspected, due to its high sensitivity and specificity, which support its high capacity to detect smaller lesions than those that appear in computed tomography (CT) with or without contrast. […] The sensitivity and specificity of CT scans are 92% and 99%, respectively, and they are considerably higher in tumors that have a high incidence of central nervous system metastasis, such as non-small-cell lung cancer.

• #12 Diagnosis and management of brain metastases: an updated review from a radiation oncology perspective

  https://www.oaepublish.com/articles/2394-4722.2019.20

  MRI exhibits an ability to detect lesions smaller than 1 cm, up to 70% more sensitive than CT, and this increases in cases of multiple metastases. […] Although clinical manifestations of a history of malignant disease with central nervous system metastasis potential may obviously occur, it will not always be possible to obtain histological confirmation of these lesions. […] Spectroscopy may increase the accuracy of MRI in differentiating tumors from necrosis in patients with metastases who have been irradiated, using choline/NAA and choline/creatine ratios. […] The therapeutic approach to patients with brain metastasis is intended to relieve symptoms, such as headache, vomiting, and neurological focalization; the success of this largely depends on the presence of cerebral hypertension syndrome secondary to perilesional cerebral edema.

• #13 Brain Metastases Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/brain-metastases/brain-metastases-diagnosis.html

  If your oncologist suspects a brain metastasis, you will be asked a series of questions about any mental, emotional or physical changes youve recently experienced. These questions can help determine if a brain metastasis is the likely cause and give doctors an idea of where the tumor might be located. […] You will then undergo a physical exam and an imaging exam, most likely an MRI (magnetic resonance imaging). This exam is the most common way to locate and confirm the diagnosis of a brain metastasis. […] If the MRI is inconclusive, doctors may order a biopsy, a procedure in which a piece of the suspected tumor is removed and then tested. […] In some cases, your physician may find the metastatic disease incidentally. This could happen if you have an imaging exam for something else, and the scan reveals a brain metastasis. When a brain metastasis is found before you begin to notice symptoms, early treatment may be able to prevent the development of neurological symptoms. […] Doctors test this fluid to check for LMD. This requires a lumbar puncture (also called a spinal tap). During this procedure, a needle is inserted into the lower back to remove a small amount of CSF from the spinal canal. This sample is then checked for cancer cells.

• #14 Metastatic Brain & Spine Tumor Symptoms & Diagnosis | Baptist Health Miami Cancer Institute

  https://baptisthealth.net/services/cancer-care/miami-cancer-institute/our-approach/adult-cancers/brain-cancer-and-central-nervous-system-tumors/metastatic-brain-and-spine-tumors/symptoms-and-diagnosis

  The signs and symptoms of a metastatic brain and spine tumor (secondary brain and spinal cord cancer) depend on the size and location of the tumor and include: […] Your doctor could discover a metastatic brain and spine tumor (secondary brain and spinal cord cancer) while evaluating your primary cancer diagnosis, or your signs and symptoms could lead your care team to conduct a neurological exam (a physical exam of your nervous system). If the results of the neurological exam suggest a tumor, your care team may conduct further testing to confirm a diagnosis. […] Specialty neuroradiologists at Miami Cancer Institute have access to advanced diagnostic tests for brain metastases. The following tests help them provide the most accurate diagnosis: […] Functional magnetic resonance imaging (fMRI) tests with gadolinium. Our specialists conduct fMRI tests with gadolinium (a contrast dye injected into a vein) to get a better picture of what is going on in your brain. Functional MRI tests allow them to record and assess your brain activity. Gadolinium is attracted to cancer cells and makes tumors of all sizes show up better in images.

• #15 Brain Metastases: Sensitivity and Specificity – GetTheDiagnosis.org

  http://www.getthediagnosis.org/diagnosis/Brain_Metastases.htm

  Often patients with a known primary cancer need to be staged to evaluate for brain metastases. This may occur in patients with neurological symptoms or those with cancers with high propensity for metastatic disease in the brain (e.g. lung cancer). […] The sensitivity and specificity of findings for Brain Metastases are listed below. […] PET/CT scan sensitivity is 27.3% and specificity is 97.6% versus MRI in patients with lung cancer. […] Contrast-enhanced Head CT sensitivity is 60% versus CE-MRI. […] Another study found sensitivity of 69% for detecting additional lesions in patients with one lesion seen on CT. […] Non-contrast MRI sensitivity is 50.8% per lesion, versus CE-MRI.

• #16 Brain Metastases | LifeBridge Health

  https://www.lifebridgehealth.org/conditions/brain-metastases

  A brain metastasis is a tumor that develops from cancer cells that have spread from other cancerous sites in the body to the brain, usually through the bloodstream. […] Brain metastases occur in approximately 20 to 40 percent of patients with cancer. […] It is important to identify the primary source of a brain metastasis, as this information is often critical to selecting the most effective treatment options. […] When a patient presents with any of the symptoms described above, doctors generally recommend a brain imaging study. […] There are two primary choices for such imaging: Computed tomography (CT) scan (also commonly referred to as a CAT scan) and Magnetic resonance imaging (MRI) scan. […] Most patients diagnosed with an abnormality on a CT scan will typically undergo an MRI as well.

• #17 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Brain-Metastases-Diagnosis-and-Treatment.aspx

  Brain metastasis may be detected during the initial screening that is performed after diagnosis of a primary cancer or through screening that is arranged if a patient begins to exhibit symptoms of brain metastasis. […] Metastatic brain tumors are diagnosed based on a combination of neurological assessment and imaging studies. More than one imaging study may be used to diagnose the tumor. Magnetic resonance imaging (MRI) and computed tomography (CT) are the most commonly used techniques. […] Magnetic resonance spectrometry is another technique that may be used to assess the brain metastasis. […] Position emission tomography (PET) scans provide information about how the tumor uses glucose, which can help the physician tell which parts of the brain tissue are healthy, cancerous, dead or swollen. […] Full body PET scans can also be performed to detect the primary site of the cancer in cases where the brain metastasis was detected first.

• #18 Metastatic Brain Tumors | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/neurosciences/expert-care-for-metastatic-brain-tumors/metastatic-brain-tumors/diagnosis

  If you have symptoms of a metastatic brain tumor, your physician will ask about your medical history, family history and risk factors. You will also likely need tests and procedures: […] Magnetic resonance imaging (MRI): This imaging technique uses radio waves and magnets to take pictures of your brain. It can show the difference between a tumor and normal tissue. […] Computed tomography (CT) scan: During a CT scan, a camera moves around you and takes X-rays to show detailed images of your brain. […] Positron emission tomography (PET) scans: A mildly radioactive dye, most often a modified sugar called FDG, is injected into the vein. It is quickly taken up by the hungry cancer cell. The scanner then captures this increased radioactivity, which that makes the cancer visible. […] Magnetic resonance spectroscopy (MRS): This imaging scan shows metabolites inside a lesion. This helps your physician gauge the likelihood of it being a tumor.

• #19 Utility of Amino Acid PET in the Differential Diagnosis of Recurrent Brain Metastases and Treatment-Related Changes: A Meta-analysis | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/64/5/816

  Amino acid PET is an established method to assist differential diagnosis of therapy-related changes versus recurrence in gliomas. However, its diagnostic value in brain metastases is yet to be determined. The goal of this study was to summarize evidence on the diagnostic utility of amino acid PET in recurrent brain metastases. […] The present meta-analysis indicates a good accuracy of amino acid PET in the differential diagnosis of recurrent brain metastases. In particular, specificity of 84% suggests that amino acid PET may reduce the number of invasive procedures and overtreatment in patients with treatment-related changes. This study provides class IIa evidence on the utility of amino acid PET in the differential diagnosis of recurrent brain metastases. […] The present meta-analysis suggests good accuracy for amino acid PET in the differential diagnosis of recurrent brain metastases. In particular, specificity of 84% indicates that amino acid PET may reduce the number of invasive procedures and overtreatment in patients with TRCs. This study provides class IIa evidence on the utility of amino acid PET in the differential diagnosis of RPBM.

• #20 Diagnosis of Metastatic Brain Cancer | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/brain-tumors-metastatic/diagnosis

  A spinal tap (lumbar puncture) is a procedure to get a sample of your spinal fluid. A pathologist will look at your spinal fluid under a microscope. […] A biopsy is rarely used to diagnose brain metastases. During this procedure, a surgeon removes a small tissue sample from your brain. A pathologist looks at the sample under a microscope for signs of cancer.

• #21 Brain Metastasis Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/1157902-workup

  Laboratory investigations include blood work, such as CBC, electrolyte panel, coagulation screen, and liver function panel. […] Specific markers, such as anti-Hu antibody in limbic encephalopathy, anti-Yo antibody in cerebellar degeneration, and anti-Ri antibody in opsoclonus and ataxia are of some value, especially in patients with small-cell lung cancer, ovarian cancer, and breast or lung cancers. […] The recent advancement in genomic and proteomic medicine allows the use of a molecular signature to gauge the risk of developing brain metastasis. […] Imaging study for metastatic disease to the brain can be divided into systemic imaging and imaging of the neuraxis. […] Head CT imaging of the brain is not as reliable as MRI in determining the extent of brain metastases. […] Tissue diagnosis should be performed in cases of uncertain etiology. […] Most surgeons advocate excision biopsy for a solitary lesion in an accessible area of the brain.

• #22 Diagnosing Metastatic Brain Tumors | NYU Langone Health

  https://nyulangone.org/conditions/metastatic-brain-tumors/diagnosis

  Diagnosing Metastatic Brain Tumors […] To diagnose brain metastases, an NYU Langone doctor performs a physical exam and asks about your medical history. He or she also looks for symptoms associated with brain metastases. For example, the doctor may evaluate your mental status by asking a series of questions; check your reflexes, balance, and ability to move muscles; and conduct vision tests. Afterward, he or she may order one or more imaging tests. […] To determine if cancer has spread to the brain, a doctor may order an MRI scanin which a magnetic field creates computerized two- or three-dimensional imagesto better view the structure of the brain. You may receive an injection of a contrast agent, or dye, to enhance the image. […] If imaging tests suggest that a person has a brain tumor but cancer has not been diagnosed, a doctor may obtain a sample of the tissue using a technique called a stereotactic biopsy. […] The doctor sends the tumor tissue to a laboratory for analysis. There, a pathologist examines it under a microscope to determine the type of metastasis a person may have. This helps your doctor create a treatment plan.

• #23 Metastatic Brain & Spine Tumor Symptoms & Diagnosis | Baptist Health Miami Cancer Institute

  https://baptisthealth.net/services/cancer-care/miami-cancer-institute/our-approach/adult-cancers/brain-cancer-and-central-nervous-system-tumors/metastatic-brain-and-spine-tumors/symptoms-and-diagnosis

  Lumbar puncture. Your care team at the Institute may recommend a lumbar puncture to check your cerebrospinal fluid (the fluid that surrounds your brain and spinal cord) for neoplastic meningitis. Also called leptomeningeal metastases, neoplastic meningitis is a complication of cancer in which cancer cells spread from a tumor to the meninges (the tissue that protects the brain and spinal cord). Your doctor obtains a sample of cerebrospinal fluid by injecting a needle between two vertebra and collecting the fluid in a container. A local anesthetic is used to numb the site of the procedure. […] Biopsy. Though rare, your care team may need to examine a small sample of tumor tissue to make a diagnosis. Our specialists are skilled in several brain tumor biopsy techniques both open and closed. The technique used depends on the location of the tumor. […] Its important to have the tumor histology and molecular profile for any patient newly diagnosed with brain metastasis. No longer is the day that we would just think that any brain metastasis is the same as any other brain metastasis.

• #24 Brain Metastasis Differential Diagnoses

  https://emedicine.medscape.com/article/1157902-differential

  Any subacute neurological disease: About 11% of mass lesions in patients with cancer are not metastases. […] Mass lesions that can masquerade as brain metastasis include abscess (20%) and granuloma (less common and mostly associated with mycobacterial or fungal infection). […] Imaging Studies […] Laboratory Studies […] Procedures […] Targeted Treatment of Brain Metastases.

• #25 Diagnosis and Treatment Options for Brain Metastasis of Melanoma | IntechOpen

  https://www.intechopen.com/chapters/21337

  After neuroimaging, confirmatory diagnosis can be accomplished through surgical biopsy or, preferably, excision of the entire mass. This allows for definitive differentiation of metastases originating from melanoma versus metastases from possible systemic cancers and other suspected etiologies. […] The presence of a lesion on a CT or MRI scan in patient with melanoma or other progressive systemic cancer is not always diagnostic for metastatic spread. […] Brain metastases from melanoma frequently appear bright on T1-weighted images and dark on T2-weighted images. […] If a single metastasis is found on CT or the scan appears within normal limits, MRI with administration of contrast is warranted because of its improved abilities for detection of lesions.

• #26 Brain metastases | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/brain-metastases?lang=us

  Brain metastases are estimated to account for approximately 25-50% of intracranial tumors in hospitalized patients. Due to great variation in imaging appearances, these metastases present a common diagnostic challenge that can importantly affect the management approach for individual patients. […] The true incidence of brain metastases is unknown, but estimates are as high as 200,000 cases per year in the United States alone. […] In patients with known malignancies, the brain can sometimes act as a reservoir for metastatic disease as traditional chemotherapy regimens can have poor permeability through the blood-brain barrier. This can lead to presentation with cerebral metastases, even with quiescent systemic disease. […] The appearance of brain metastases is variable depending on their size, location and histology, and they can mimic other pathologies such as high-grade gliomas and infections.

• #27 Brain metastases | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/brain-metastases?lang=us

  Although they most often occur at the grey-white matter junction or in the arterial watershed areas, they can occur essentially anywhere in the neuraxis. […] MRI remains gold-standard to rule out small metastases. […] Overall patients with brain metastases typically have a mean survival of one month without treatment. With treatment, survival improves, but it is still dismal. The mean age of survival is still less than one year, although in some patients with solitary metastases, longer survival is encountered. […] A 2016 trial showed that whole-brain radiation therapy did not improve the overall survival for those patients with a limited number of brain metastases, and was associated with more cognitive impairment.

• #28 LearnOncology

  https://www.learnoncology.ca/modules/brain-metastases

  Brain metastases occur in between 10-30% of cancer patients, and are the most common intracranial tumours in adults. […] Symptomatic brain metastases warrant urgent treatment to improve neurological deficits and quality of life and prevent further neurological deterioration, particularly sequelae of increased intracranial pressure, with brain herniation being the most serious. […] In a patient with suspected brain metastases, contrast-enhanced MRI the preferred imaging modality. […] Imaging findings suggesting brain metastases include the following: The presence of multiple lesions, Localization at the junction of the grey and white matter, Circumscribed margins, Large amounts of vasogenic edema compared with the size of the lesion. […] If the diagnosis remains in doubt with imaging, a biopsy should be obtained.

• #29 What are the tests for diagnosing brain tumours? | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/brain-tumours/getting-diagnosed/what-are-the-tests

  A biopsy means taking a small tissue sample from your brain tumour and looking at it under a microscope. […] Doctors take samples of tissue (biopsy) to look at under a microscope. This helps your doctor decide the best treatment for you. […] Certain types of brain tumours can spread from the brain to the CSF. So doctors might take some of the CSF to test for tumour cells. […] Some brain tumours such as pituitary gland, pineal region and germ cell tumours can change the levels of certain hormones and chemicals in your body. You may have blood tests to check for specific hormones and markers to help diagnose a brain tumour. […] The tests you have helps your doctor find out if you have a brain tumour and how it might behave. This is the grade of the tumour. […] This is important because doctors recommend your treatment according to the type and grade of the tumour.

• #30 Brain Metastasis | Mays Cancer Center

  https://cancer.uthscsa.edu/cancer-care/types-and-treatments/brain-metastasis

  Molecular tests study the genetic or molecular details of cancer cells. These details help doctors recommend treatments designed to destroy a specific type of cancer cell. […] At regular tumor board meetings, several brain tumor specialists (including neuropathologists, neuro-oncologists and neurosurgeons) review your test results together. This teamwork helps provide a precise diagnosis and personalized approach.

• #31 New guidelines for the diagnosis and treatment of brain metastases

  https://www.meduniwien.ac.at/web/en/ueber-uns/news/2021/news-im-august-2021/neue-guidelines-zur-diagnose-und-behandlung-von-hirnmetastasen/

  Brain metastases are a common and dangerous complication in cancer patients. Under the leadership of experts from MedUni Vienna, two of the largest international oncology societies have published new clinical guidelines for the diagnosis and treatment of brain metastases from solid tumours. […] The recently published joint recommendations, from the European Association of Neuro-Oncology (EANO) and the European Society for Medical Oncology (ESMO), for the diagnosis and treatment of parenchymal brain metastases from solid tumours include the very latest methods for prevention, diagnosis, treatment, and follow-up. […] In the field of diagnostics, the liquid biopsy method is becoming increasingly important, as well as the examination of tumour tissue. Molecular analyses of blood or cerebrospinal fluid samples reveal genetic changes that can be used as a basis for selecting targeted, modern treatments.

• #32 30-day mortality in patients treated for brain metastases: extracranial causes dominate | Radiation Oncology | Full Text

  https://ro-journal.biomedcentral.com/articles/10.1186/s13014-022-02062-x

  Established prognostic models, such as the diagnosis-specific graded prognostic assessment, were not designed to specifically address very short survival. […] We hypothesized that in-depth evaluation of a carefully defined cohort with short survival, arbitrarily defined as a maximum of 3 months, may provide signals and insights, which facilitate the development of a 30-day mortality model. […] Retrospective analysis (20112021) of patients treated for brain metastases with different approaches. […] Risk factors for 30-day mortality from radiosurgery or other primary treatment were evaluated. […] The cause of death was unrelated to brain metastases in 61%. […] Logistic regression analysis showed 9 factors associated with 30-day mortality (each assigned 36 points) and a point sum was calculated for each patient.

• #33 30-day mortality in patients treated for brain metastases: extracranial causes dominate | Radiation Oncology | Full Text

  https://ro-journal.biomedcentral.com/articles/10.1186/s13014-022-02062-x

  Eighty-three percent of patients in the highest risk group (16 points) died within 30 days, and none survived for more than 2 months. […] However, many cases of 30-day mortality (more than half) occurred in intermediate risk categories. […] Extracranial tumor progression was the prevailing cause of 30-day mortality and few, if any deaths could be considered relatively unexpected when looking at the complete oncological picture. […] We were able to develop a multifactorial prediction model. […] However, the models performance was not fully satisfactory and it is not routinely applicable at this point in time, because external validation is needed to confirm our hypothesis-generating findings.

• #34

  https://brainmetgpa.com/

  The Graded Prognostic Assessment (GPA) estimates survival for patients with brain metastases. Survival and the factors that predict survival vary by diagnosis and the molecular profile of the patient’s tumor. […] Summary report on the Graded Prognostic Assessment (GPA): an accurate and facile diagnosis-specific tool to estimate survival, guide treatment and stratify clinical trials for patients with brain metastases. […] The Graded Prognostic Assessment (GPA): A new diagnosis-specific prognostic index for women with breast cancer and brain metastases. […] Diagnosis-specific prognostic factors, indices and treatment outcomes for patients with newly-diagnosed brain metastases: a multi-institutional analysis of 4259 patients.

• #35 Epidemiology and survival outcomes of synchronous and metachronous brain metastases: a retrospective population-based study in: Neurosurgical Focus Volume 55 Issue 2 (2023) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/55/2/article-pE3.xml

  Brain metastases (BMs) are the most common CNS tumors, yet their prevalence is difficult to determine. Most studies only report synchronous metastases, which make up a fraction of all BMs. The authors report the incidence and prognosis of patients with synchronous and metachronous BMs over a decade. […] Metachronous BM was defined as BM diagnosed more than 2 months after the primary cancer. […] Of all BMs, 113,827 (37.8%) presented synchronously and 187,036 (62.2%) presented metachronously. […] Metachronous BM diagnosis was associated with longer survival over synchronous BM from primary diagnosis (11.54 vs 37.41 months, p 0.0001), but shorter survival than extracranial metastases without BM (38.75 vs 69.18 months, p 0.0001). […] Antineoplastic therapy prior to BM was associated with improved BM-free survival (4.46 vs 17.80 months, p 0.0001) and OS (25.15 vs 42.26 months, p 0.0001). […] The majority of BMs present metachronously and arise within 2 years of primary cancer diagnosis. […] Antineoplastic therapy prior to the development of BM may prolong the time before metastasis and improve survival.

• #36 Brain metastases | MedLink Neurology

  https://www.medlink.com/articles/brain-metastases

  Screening asymptomatic patients for brain metastases in newly diagnosed patients with lung cancer and melanoma has become standard practice. […] Follow-up imaging is recommended every 2 to 3 months for the first 1 to 2 years after initial treatment. […] Cerebrospinal MRI with or without contrast is considered the gold standard imaging method for the diagnosis of patients with leptomeningeal metastases.

• #37 The Diagnosis of Brain Metastases

  https://www.curetoday.com/view/the-diagnosis-of-brain-metastases

  Now well move on to the next segment. Lets talk about the diagnosis of brain metastases. Dr. Ahluwalia, tell us about how brain metastases are usually diagnosed and what do you look for? […] Whenever we have patients who have lung cancer, and in Ivys case this was done, we do a screening MRI [magnetic resonance imaging] at diagnosis of a stage 4 lung cancer, and we like to do MRI unless its contraindicated, because we know MRIs are much more likely to pick out a small brain metastasis. […] Clearly, the morality of choice is an MRI whenever you need to screen for brain metastases. […] Maintaining a high degree of awareness is helpful, especially in patients who may have a greater chance of developing a brain metastases thats stage 4 lung cancer, HER2-positive breast cancer, triple negative breast cancer, especially with stage 4 diseases in these and then patients who have BRAF mutations in their melanoma, which is 50% of patients with melanoma. […] Then theres always a suspicion so ordering a brain MRI sooner rather than later is helpful and at least ruling out if someone has a brain metastasis or not.

• #38 Estimating the risk of brain metastasis for patients newly diagnosed with cancer | Communications Medicine

  https://www.nature.com/articles/s43856-024-00445-7

  Brain metastases (BM) affect clinical management and prognosis but limited resources exist to estimate BM risk in newly diagnosed cancer patients. […] We aimed to develop and validate models to predict risk of BM at diagnosis for the most common cancer types that spread to the brain. […] The proportion of patients with BM at diagnosis is 0.3%, 1.5%, 1.3%, 0.3%, 16.0%, and 10.3% for breast cancer, melanoma, kidney cancer, CRC, SCLC, and NSCLC, respectively. […] We develop accurate models that predict the BM risk at diagnosis for multiple cancer types. The nomograms and Webtool may aid clinicians in considering brain MRI at the time of initial cancer diagnosis. […] Given the limitations of the current guidelines regarding brain MRI for patients with a new diagnosis of cancer, we aimed to develop and validate cancer-specific models to predict the presence of BM at time of cancer diagnosis.

• #39 Estimating the risk of brain metastasis for patients newly diagnosed with cancer | Communications Medicine

  https://www.nature.com/articles/s43856-024-00445-7

  This study successfully developed and validated disease-specific models to predict the presence of BM in patients with a new cancer diagnosis. […] The models for breast cancer, melanoma, kidney cancer, and CRC exhibited excellent to outstanding discrimination with average AUC values based on random training/testing data splitting all larger than 0.87. […] This study can be incorporated into guidelines for cancer staging and the nomograms and webtools developed based on our models will aid oncologists in the clinic by giving a pre-test probability of the presence of BM when considering brain imaging. […] In conclusion, we developed and validated models that predict the presence of BM at diagnosis for patients diagnosed with breast cancer, melanoma, CRC, kidney cancer, NSCLC and SCLC.

• #40 Metastatic Brain Tumors – AANS

  http://www.aans.org/patients/conditions-treatments/metastatic-brain-tumors/

  If a metastatic tumor is suspected, the treating neuro-oncologist or neurosurgeon may ask for further testing. Additional imaging of the body may be requested and is obtained generally in the form of a CT with contrast of the chest, abdomen and pelvis and a bone scan. These tests allow detection of a primary neoplasm elsewhere in the body. Additional testing may be indicated at times, but this constitutes the basic palette of tests.

• #41 Brain Metastases Causes, Symptoms, and Treatments | UPMC Hillman

  https://hillman.upmc.com/cancer-care/brain-nervous-system/brain-tumor/brain-metastases

  Brain metastases are cancers in the brain that started somewhere else in the body. […] How do you diagnose brain metastases? […] If the doctor suspects a brain tumor based on this assessment, they’ll order the following tests. […] MRI to diagnose brain cancer […] This is the most common test to diagnose a brain metastasis. […] Sometimes, doctors find a brain metastasis before they find the primary cancer. […] In these cases, the doctor will order blood tests to look for markers, or proteins, in the blood. […] Your doctor may do a biopsy. […] The doctor may also order a chest CT scan or PET scan to look for cancer elsewhere in the body.

• #42 < ?php wp_title( '|', true, 'right' ); ?>

  https://surgicalneurologyint.com/surgicalint-articles/neuropathology-of-brain-metastases/

  Metastatic tumors are the most common neoplasms encountered in the central nervous system (CNS), and continue to be major cause for mortality and morbidity. […] The first step in the diagnosis of a metastatic brain lesion is to exclude a primary CNS tumor, followed by verification or identification of the primary tumor and the site. […] When morphological features are not enough to establish a definitive diagnosis, additional studies including immunohistochemical stains are applied. […] This review summarizes the diagnostic approach to CNS metastases, immunohistochemical assessment of neoplasm of unknown primary, and primary CNS lesions entering in the differential diagnosis of metastases. […] The second step in the diagnosis of metastatic brain tumors is to either verify or identify the primary tumor and the site.

• #43 < ?php wp_title( '|', true, 'right' ); ?>

  https://surgicalneurologyint.com/surgicalint-articles/neuropathology-of-brain-metastases/

  When the microscopic features of the metastatic tumors are similar to the known primary tumor, the diagnosis is straightforward. […] However, the grade and degree of differentiation may vary, with more anaplastic tumors often requiring ancillary IHC studies for confirmation. […] The general goal is to subtype the tumor, so that the site of origin is established and tumor specific therapy may be initiated. […] Although the main principles are same, there are slight variations in the approach to the NUP in the CNS versus other regions.

• #44

  https://link.springer.com/article/10.1007/s10014-016-0275-3

  Confronted with brain metastases (BM), pathologists aim to rule out a primary central nervous system (CNS) tumor and to identify or verify the primary tumor site to guide the clinician to specific therapies. […] Apart from morphological features, ancillary immunohistochemical analysis is the most effective tool for characterizing a metastatic neoplasm of unknown origin. […] Appropriate strategies for molecular and immunohistochemical analysis are needed to identify theranostic markers. […] This article aims to review the anatomopathological diagnostic approach for BM in the age of targeted therapies.

• #45 Imaging of Brain Metastases: Diagnosis and Monitoring | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-23417-1_12

  Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity. […] Use of susceptibility-weighted imaging (SWI) in the detection of brain hemorrhagic metastases from breast cancer and melanoma. […] Assessment of irradiated brain metastases using dynamic contrast-enhanced magnetic resonance imaging. […] Differentiation of glioblastoma multiforme from metastatic brain tumor using proton magnetic resonance spectroscopy, diffusion and perfusion metrics at 3 T. […] Distinguishing recurrent intra-axial metastatic tumor from radiation necrosis following gamma knife radiosurgery using dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging.

• #46 Brain Metastasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470246/

  Whole-brain radiotherapy provides control of individual brain metastases as well as reduces the risk of failure in the brain at a new site. […] The management of patients with brain metastases is best done with an interprofessional team that includes a neurosurgeon, an oncologist, neurologist, radiation therapist, palliative care specialist, pain consultant, anesthetist.

• #47 How We Diagnose Brain Tumors | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/brain-tumors/diagnosis

  At the Center for Neuro-Oncology at Dana-Farber Brigham Cancer Center, we understand that waiting for a formal diagnosis is a difficult time for you and your family. Our experts work together efficiently to complete the multi-step process and reach a precise diagnosis as quickly as possible, so that you can start your treatment without delay. […] To establish an accurate diagnosis, you will undergo a series of tests based on your symptoms, the location and nature of your tumor, and your personal health history. […] Since our neuro-oncology clinicians focus solely on the treatment of brain tumors, spinal cord tumors, and neurological complications from cancer, they have deep expertise in diagnosing and treating all forms of brain tumors, even rare types. […] Complex brain cancer cases requiring multidisciplinary care are reviewed by the brain tumor diagnostic board and the treatment tumor board at weekly meetings that include representatives from all neuro-oncology clinical specialties. Results of all tumor tissue pathology tests are reviewed, and approaches to treatment are discussed.

• #48 What are Brain Metastases? Symptoms, Risk Factors & Treatments | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/brain-metastases.html

  Brain metastases are growths that spread to the brain from a cancer in another part of the body. They are distinct from primary brain tumors, which start in the brain. […] The number of brain metastasis diagnoses has actually risen recently. Many doctors believe this is due to better early detection of brain metastases, as well as better treatments for primary cancers. […] When a patient is diagnosed with a brain metastasis, treating that growth becomes a top priority. […] At MD Anderson, your case can be reviewed by our central nervous system metastases tumor board. […] Members of this team have spent decades treating patients with brain metastases. […] As a patient at a top-ranked cancer center, you will also benefit from advanced imaging techniques that can identify and track your brain metastasis over time.

• #49 Brain metastases – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-metastases/diagnosis-treatment/drc-20350140

  Appointments can be brief, and there’s a lot to discuss. […] What kinds of tests do I need? […] What treatments are available, and which do you recommend? […] What are the possible side effects of each treatment? […] How long will the treatment last? […] What’s my prognosis? […] What experimental treatments or clinical trials are available to me?

• #50 Symptoms and Diagnosis of Brain Metastases – Brainlab.org

  https://www.brainlab.org/get-educated/brain-metastasis/investigate-brain-metastasis/symptoms-and-diagnosis-of-brain-metastases/

  Other Potential Imaging Techniques […] You have likely already undergone body scans for your primary condition. Discuss with your doctor or nurse, in detail, how the brain scans are similar and different from previous scans. Knowing where and when to go and how the scan works will help reassure you and better prepare you for the experience. Your doctor may even prescribe additional CT scans of your chest, abdomen and pelvis as well as a bone scan to detect any primary cancer elsewhere in the body. […] If you are diagnosed with brain metastases, this will likely be the first of many brain scans that will happen during your treatment. It is wise to keep a history and a digital copy of all your scans to better inform the different medical teams that you may work with during your treatment.

• #51 Imaging of Brain Metastases: Diagnosis and Monitoring | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-23417-1_12

  Brain metastases are the most frequent brain tumors in adults and represent about 25% of brain masses. Among patients with metastatic cancer, 40% will present with brain metastases. These lesions are less frequently symptomatic than expected: only 19% of patients with newly diagnosed brain metastases have neurologic symptoms whereas these lesions dramatically change patients prognosis. We will see in this chapter that imaging is central for patients care. […] Assessment of brain metastases with dynamic susceptibility-weighted contrast-enhanced MR imaging: initial results. […] The effect of contrast dose, imaging time, and lesion size in the MR detection of intracerebral metastasis. […] Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes.

• #52 LearnOncology

  https://www.learnoncology.ca/modules/brain-metastases

  Symptomatic brain metastases warrant urgent treatment to improve symptoms and prevent further neurological deterioration. […] Initial management should focus on ensuring the stability of the patient’s airway, breathing and circulation, followed by management of symptoms. […] Corticosteroids are used to treat symptomatic edema from brain metastases. […] Treatment of brain metastases depends on a number of factors. […] Whole brain radiation therapy (WBRT) is frequently used in the setting of multiple brain metastases, and improves neurological symptoms and survival. […] Patients treated for brain metastases should undergo surveillance using MRI or CT in order to detect recurrence early. […] While survival is variable, depending on the primary tumour, untreated across all malignancies, median survival in the setting of brain metastases is 1-2 months.

• #53 Early detection of brain metastases and appropriate local therapy followed by systemic chemotherapy may improve the prognosis of gastric cancer | Scientific Reports

  https://www.nature.com/articles/s41598-023-46933-z

  The purpose of this study was to clarify the factors that support the continuation of chemotherapy for G/GEJ cancer with brain metastasis as long as possible. […] The clinical characterization of the timing and course of brain metastases may help prevent the unexpected discontinuation or interruption of systemic chemotherapy due to brain metastases, which in turn, may lead to longer OS. […] The median survival time (MST) from G/GEJ cancer diagnosis was 14.9 months in patients with brain metastasis detected during the treatment period, and the MST from the diagnosis of brain metastasis was 2.8 months. […] Patients who could receive chemotherapy exhibited significant prolongation of survival compared with patients who could not (12.4 months vs. 1.0 month, p0.001). […] The MST from brain metastasis diagnosis was 7.8, 5.3, 0.8, and 0.8 months in the surgery, SRT, WBRT, and BSC groups, respectively.

• #54 Early detection of brain metastases and appropriate local therapy followed by systemic chemotherapy may improve the prognosis of gastric cancer | Scientific Reports

  https://www.nature.com/articles/s41598-023-46933-z

  These findings indicate that treatment with WBRT alone does not improve survival time compared with treatment with BSC. […] This suggests that, even in patients with distant metastases to other organs, local control of brain metastases by SRT and surgery followed by appropriate systemic chemotherapy are critical for improving prognosis.

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