M. Vandepol et al., BRAIN METASTASES FROM AN UNKNOWN PRIMARY TUMOR - WHICH DIAGNOSTIC PROCEDURES ARE INDICATED, Journal of Neurology, Neurosurgery and Psychiatry, 61(3), 1996, pp. 321-323
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 u
nknown in 18 patients. Lung cancer was the most common primary tumour
(72%), followed by breast cancer, colon carcinoma, and melanoma. On ph
ysical examination, 51 patients had organ specific symptoms or signs p
roviding guidelines to the diagnostic evaluation. In 24 of the 52 pati
ents with a primary lung tumour, and in four of the 20 patients withou
t, organ specific complaints or findings suggested this tumour type, r
esulting in a positive predictive value of 85%. Overall, radiography a
nd CT of the chest were very useful in detection of primary lung tumou
rs. This could partly be explained by the high prior probability of de
tecting such tumours. Other diagnostic procedures should be used on in
dication only. The prognosis of patients with confirmed primary tumour
position did not differ from those with unidentified primary tumour.