Ingo Fiss1, Abdelhalim Hussein2, Alonso Barrantes-Freer3, Swetlana Sperling2, Silvia Hernandez-Duran2, Christina Wolfert2, Tobias Pukrop4, Milena Ninkovic2, Annalen Bleckmann5, Veit Rohde2, Dorothee Mielke2, Bawarjan Schatlo2. 1. Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany. ifweb@web.de. 2. Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany. 3. Department of Neuropathology, Medical Center, Leipzig University, Leipzig, Germany. 4. Department of Internal Medicine III, Hematology and Medical Oncology, University Hospital Regensburg, Regensburg, Germany. 5. Department of Internal Medicine, Hematology and Oncology, Medical Center, Georg August University of Göttingen, Göttingen, Germany.
Abstract
BACKGROUND: Brain metastases (BMs) are the most frequent malignancy of the central nervous system. Previous research suggested that some metastases show infiltrative behavior rather than sharp demarcation. We hypothesized that three magnetic resonance (MR) imaging parameters-(a) tumor size, (b) extent of peritumoral edema, and (c) presence of multiple BMs-are predictors of cellular invasion beyond the surgically identifiable tumor margins. METHODS: We performed a post hoc analysis on prospectively collected data of patients with BMs. Biopsies beyond the resection margin and immunohistochemistry were performed to assess infiltration status. The three MR imaging parameters were dichotomized into diameters ≤ 30 mm ("small") and > 30 mm ("large"), amount of peritumoral edema "extended" and "limited," and "multiple BMs" and "single BMs," respectively. The association between infiltration status and imaging parameters was calculated using chi-square test. RESULTS: Biopsy beyond the resection margin was performed in 77 patients; 49 (63.6%) had supramarginal infiltration and 28 patients (36.4%) showed no infiltration. Histological evidence of tumor infiltration was found in 25/41 patients with smaller lesions (61%) and in 24/36 with larger lesions (66.7%, p = 0.64), in 28/44 patients with limited (63.6%) and in 21/33 patients with extended edema (63.6%, p = 1.0), in 28/45 patients (62.2%) with single BM and in 21/32 patients (65.6%) with multiple BMs (p = 0.81). CONCLUSIONS: Based on the post hoc analysis of our prospective trial data, we could not confirm the hypothesis that infiltration of brain parenchyma beyond the glial pseudocapsule is associated with the MR imaging parameters tumor size, extent of edema, or multiplicity of metastases.
BACKGROUND: Brain metastases (BMs) are the most frequent malignancy of the central nervous system. Previous research suggested that some metastases show infiltrative behavior rather than sharp demarcation. We hypothesized that three magnetic resonance (MR) imaging parameters-(a) tumor size, (b) extent of peritumoral edema, and (c) presence of multiple BMs-are predictors of cellular invasion beyond the surgically identifiable tumor margins. METHODS: We performed a post hoc analysis on prospectively collected data of patients with BMs. Biopsies beyond the resection margin and immunohistochemistry were performed to assess infiltration status. The three MR imaging parameters were dichotomized into diameters ≤ 30 mm ("small") and > 30 mm ("large"), amount of peritumoral edema "extended" and "limited," and "multiple BMs" and "single BMs," respectively. The association between infiltration status and imaging parameters was calculated using chi-square test. RESULTS: Biopsy beyond the resection margin was performed in 77 patients; 49 (63.6%) had supramarginal infiltration and 28 patients (36.4%) showed no infiltration. Histological evidence of tumor infiltration was found in 25/41 patients with smaller lesions (61%) and in 24/36 with larger lesions (66.7%, p = 0.64), in 28/44 patients with limited (63.6%) and in 21/33 patients with extended edema (63.6%, p = 1.0), in 28/45 patients (62.2%) with single BM and in 21/32 patients (65.6%) with multiple BMs (p = 0.81). CONCLUSIONS: Based on the post hoc analysis of our prospective trial data, we could not confirm the hypothesis that infiltration of brain parenchyma beyond the glial pseudocapsule is associated with the MR imaging parameters tumor size, extent of edema, or multiplicity of metastases.
Authors: Raquel Blazquez; Martin Andreas Proescholdt; Marlene Klauser; Karl-Michael Schebesch; Christian Doenitz; Daniel Heudobler; Lena Stange; Markus J Riemenschneider; Elisabeth Bumes; Katharina Rosengarth; Andreas Schicho; Nils-Ole Schmidt; Alexander Brawanski; Tobias Pukrop; Christina Wendl Journal: Front Oncol Date: 2022-04-04 Impact factor: 5.738