Clinicopathologic Characteristics of Primary Bronchial Cancer Metastasizing to the Brain
Brain metastasis is one of the most important factors influencing the quality of life in lung cancer patients with metastatic disease.
We analyzed the clinicopathological data of 163 lung cancer patients with brain metastasis (96 men, 67 women). The brain metastasis was diagnosed either by CT (n=119) or MRI (n=44). The lung cancer was diagnosed according to bronchoscopy, surgical resection VATS biopsy or transtoracic needle biopsy. The lung tumor was diagnosed cytologically in 43 cases, and histologically in 120 cases.
The histological distribution was the following: 67 adenocarcinomas, 43 small cell lung cancers, 22 squamous cell cancers, 12 anaplastic carcinomas,1 adenosquamous carcinoma, 2 atypical carcinoid tumors and 16 malignant tumors.
At the time of diagnosis 24% of our patients were operable, while in 98 cases (63.6%) the desease were already at stage IV.
Central tumors were found in 64.3%, and peripheral in 35.7%. In 103 cases (64%) the tumor was in the right lung. The upper lobe was concerned in 92 cases (56.4%). There were 58 tumors in the right upper lobe, and 34 in the left upper lobe. 20 tumors were in the right lower lobe, 9 in the left lower lobe,11 in the middle lobe.
When compared small cell lung cancer to adenocarcinoma, the proportion of early metastasis (< 3 months) was significantly higher (p<0.05).
Brain metastasis was observed most frequently in adenocarcinomas localized to the upper lobes, and among them the proportion of early metastasis was very high. According to our results, especially in case of upper lobe adenocarcinoma, the exclusion of intracranial metastasis by brain MRI is highly desirable before surgical resection of lung cancer.
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