Suspected spinal cord compression in breast cancer patients: A multidisciplinary risk assessment

Breast cancer is the most common cause of metastatic epidural spinal cord c ompression (SCC) in women, and this condition results in significant neurol ogic dysfunction and morbidity. Prior studies of patients with suspected SC C did not employ multivariate analysis techniques, often included persons w ith a wide variety of malignancies, and generally focused on identifying as sociated neurologic and radiologic features. We therefore conducted a study examining a more comprehensive set of potential clinical risk factors in b reast cancer patients with suspected SCC. We retrospectively analysed 123 episodes of suspected SCC among 93 breast c ancer patients evaluated by spine computed tomography (CT) scanning. Multip le logistic regression analysis was employed to identify independent predic tors of SCC. Clinically significant metastatic epidural cancer was defined as thecal sac compression (TSC), which occurred in 33 episodes (27%). Four independent predictors of TSC were identified and included oncologic featur es (known bone metastases greater than or equal to 2 years, metastatic dise ase at initial diagnosis) in addition to neurologic and radiologic features (objective weakness, vertebral compression fracture on spine radiograph). These four predictors stratified episodes into subgroups with widely varyin g risks of TSC, ranging from 12% (0 risk factors) to 85% (greater than or e qual to 3 risk factors). These results suggest that the evaluation of breast cancer patients with su spected SCC should include clinical information about their disease course in addition to neurologic examination and prior imaging studies. If confirm ed, these predictors may help clinicians assess risk in this patient popula tion.