Leptomeningeal metastases in malignant solid tumors: clinical manifestations and diagnosis

Abstract

Objective To improve the understanding of leptomeningeal metastasis (LM), we analyzed the data of clinical manifestations, imaging findings and cytological analysis of cerebrospinal fluid (CSF) in a group of patients with LM of malignant solid tumors. Methods The clinical data of 94 patients with LM of malignant solid tumors between 2009 and 2014 in our hospital were retrospectively analyzed. We compared the clinical manifestations and auxiliary examinations of patients with different pathological types of LM. The Chi-square test was used to compare the results. Results The pathological types included adenocarcinoma (61), small cell carcinoma (24), squamous carcinoma (6), melanoma (1), large-cell carcinoma (1), and hepatocellular carcinoma (1). The median age was 58 (37-75) and the median KPS score was 40 (10-80). About 98.9% (93/94) patients had neurologic symptoms. Neuroimaging examination was performed in 84 patients, with the sensitivity of 88.1% (74/84); cytological analysis of CSF was performed in 85 patients, with the sensitivity of 88.2% (75/85); while CSF biochemical examination was performed in 85 patients, with the sensitivity of 90.6% (77/85). The sensitivity of cytology in adenocarcinoma (96.6%, 56/58) was higher than those in small cell carcinoma (80%, 16/20; P=0.056). The sensitivity of neuroimaging in small cell carcinoma (95.8%, 23/24) was higher than that in adenocarcinoma (83.3%, 45/52; P=0.409). However, the sensitivity of cytology (1/5) and neuroimaging (4/6) in squamous carcinoma was low, which led to the need of comprehensive analysis for the diagnosis. The incidence of headache, spinal nerve-related symptoms, ependymal enhancement and metastatic nodules of lumbosacral intraspinal in adenocarcinoma and small cell carcinoma showed statistically significant difference, which was 88.5% (54/61) and 29.2% (7/24; P<0.01), 18.0% (11/61) and 45.8% (11/24; P=0.008), 2/6 and 25.0% (6/24; P=0.017), 1.9% (1/61) and 50.0% (12/24; P<0.01), respectively. Conclusions Neuroimaging and CSF examination are still the key points for the diagnosis of LM of malignant solid tumors. The clinical manifestations are correlated with pathological types of primary tumor. Key words: Meningeal neoplasms; Neoplasm metastasis; Carcinoma, small cell; Adenocarcinoma; Neuroimaging; Cytodiagnosis