NEIM-01 INCIDENCE AND DIAGNOSTIC TECHNIQUES FOR LEPTOMENINGEAL DISEASE IN PATIENTS WITH BRAIN METASTASIS. (5th August 2022)

• Record Type: Journal Article
• Authors: Henry, Katie; Overholt, Brandon; Sinson, Grant; Pinheiro, Fernando Santos; Bovi, Joseph
• Is Part Of: Neuro-oncology advances. Volume 4(2022)Supplement 1
• Page Start: i17
• Page End: i17
• Publication Date: 2022-08-05
• Subjects: 616.99481
• DOI: 10.1093/noajnl/vdac078.068
• Languages: English
• ISSNs: 2632-2498

Abstract

Abstract: BACKGROUND: Leptomeningeal disease (LMD) is malignant infiltration of the pia mater and cerebrospinal fluid (CSF) space. LMD carries a poor prognosis with median survival of a few months. Annually, 110, 000 patients in the United States are diagnosed with LMD. The incidence is rising because of improvements in control of primary cancers and recognizing that LMD is a late sequelae of some malignancies. Definitive diagnosis of LMD is made by CSF cytology and/or spine MRI, although neither tool shows robust sensitivity. The diagnostic challenges for LMD have led to a lack of uniformity in the diagnostic approach. METHODS: A systematic chart review of brain metastasis patients was conducted at Froedtert Hospital between 2019-2021. Information on primary cancer, LMD suspicion, work up, confirmation, treatment, and survival were collected and analyzed. RESULTS: Among 151 patients with brain metastasis, 86 were suspected and 29 were confirmed to have LMD. Of the confirmed patients, the most common primary cancers were lung (n=8, 27.6%) and breast (n=8, 27.6%). Most patients (n=24, 82.8%) underwent both LP and MRI. LMD was confirmed by positive cytology in a minority of cases (n=9, 31%), with most patients being confirmed by positive MRI or clinical findings alone (n=20, 69%). All LPs had over 10 mL of CSF sent to analysis. A median of 2 LPs were required before a positive cytology confirmed the diagnosis. Due to small sample size, no statistical analysis was made to correlate positive LP with primary cancer sites. CONCLUSION: Less than one third of cancer patients with confirmed LMD have positive cytology, despite the majority (>80%) of them undergoing LP. The dissonance between diagnostic strategies and confirmatory results is expected considering the low sensitivity of LPs; however, it highlights the need for more precise diagnostic tools, and development of a data-based strategy for LMD confirmation.