Prediction of intracranial metastases in cancer patients with headache
- 28 March 2002
- Vol. 94 (7), 2063-2068
- https://doi.org/10.1002/cncr.10379
Abstract
BACKGROUND The current study was conducted to investigate the diagnostic value of neurologic evaluation for the prediction of intracranial metastases in cancer patients with new or changed headache. METHODS Between February 1997 and February 2000, general practitioners and specialists referred cancer patients with new or changed headache to the Department of Neurology at the study institution. All patients underwent a structured history and neurologic examination. Magnetic resonance imaging (MRI) of the brain was used as the gold standard for determining the presence of intracranial metastases. The association between baseline patient characteristics, history variables, and variables from the neurologic examination in patients with intracranial metastases was evaluated by univariate and multivariate logistic regression analyses in combination with receiver operating characteristic (ROC) curve analyses. RESULTS Sixty‐eight consecutive patients were included in the current study (48 females and 20 males). The mean age of the patients was 57 years (range, 24–88 years; standard deviation ± 13.3 years). Breast carcinoma was the primary tumor in 32 patients (47.1%) and lung carcinoma was the primary tumor in 12 patients (17.6%). Intracranial metastases occurred in 22 patients (32.4%). The occurrence of intracranial metastases was predicted in the multivariate logistic regression analyses by one baseline patient characteristic variable and 2 history variables (i.e., headache duration of ≤ 10 weeks [odds ratio (OR) of 11.0; 95% confidence interval (95% CI), 1.1–108.2], emesis [OR of 4.0; 95% CI, 1.1–14.3], and pain not of tension‐ type [OR of 6.7; 95% CI, 1.8–25.1]). No variable from the neurologic examination was found to add information to the prediction model. When at least one of the three predictors was present, all patients with intracranial metastases could be identified with this prediction model. MRI could be omitted in 12 patients (26%) without intracranial metastases. The ROC area under curve of this model was 0.83. CONCLUSIONS Intracranial metastases were found in 32.4% of the cancer patients with headache as the presenting symptom. Although 3 significant clinical predictors were found (headache duration ≤ 10 weeks, emesis, and pain not of tension‐ type), few patients could be excluded from undergoing MRI because of a low specificity. Therefore, MRI of the brain was considered to be warranted in all patients in the current study. Cancer 2002;94:2063–8. © 2002 American Cancer Society. DOI 10.1002/cncr.10379Keywords
This publication has 12 references indexed in Scilit:
- Identification of prognostic factors in patients with brain metastases: a review of 1292 patientsInternational Journal of Radiation Oncology*Biology*Physics, 1999
- Isolated Headache as the Presenting Clinical Manifestation of Intracranial Tumors: A Prospective StudyCephalalgia, 1994
- Headache in Brain Tumor: A Cross‐Sectional StudyHeadache: The Journal of Head and Face Pain, 1994
- Headaches in patients with brain tumorsNeurology, 1993
- Treatment of single brain metastasis: Radiotherapy alone or combined with neurosurgeryAnnals of Neurology, 1993
- The spectrum of neurological disease in patients with systemic cancerAnnals of Neurology, 1992
- A Randomized Trial of Surgery in the Treatment of Single Metastases to the BrainThe New England Journal of Medicine, 1990
- Distribution of Brain MetastasesArchives of Neurology, 1988
- Radation therapy for brain metastasesAnnals of Neurology, 1980