Cancer Res Treat.  2024 Oct;56(4):1105-1112. 10.4143/crt.2024.138.

Dural Metastasis in Breast Cancer: MRI-Based Morphological Subtypes and Their Clinical Implications

• Ahn SJ
• Joo B
• Park M
• Park HH
• Suh SH
• Ahn SG
• Yoo J

• KMID: 2560245
• DOI: http://doi.org/10.4143/crt.2024.138

Abstract

Purpose
This study aimed to investigate the clinical factors associated with breast cancer (BRCA) dural metastases (DMs), their impact on prognosis compared to brain parenchymal metastases (BPMs) alone, and differences between DM subtypes, aiming to inform clinical decisions.
Materials and Methods
We retrospectively analyzed 119 patients with BRCA with brain metastasis, including 91 patients with BPM alone and 28 patients with DM. Univariate and multivariate analyses were performed to compare the clinical characteristics between the two groups and within subtypes of DM. Overall survival after DM (OSDM) and the interval from DM to leptomeningeal carcinomatosis (LMC) were compared using Kaplan-Meier analysis.
Results
DM was notably linked with extracranial metastasis, luminal-like BRCA subtype (p=0.033), and skull metastases (p < 0.001). Multiple logistic regression revealed a strong association of DM with extracranial and skull metastases, but not with subtype or hormone receptor status. Patients with DM did not show survival differences compared with patients with BPM alone. In the subgroup analysis, nodular-type DM correlated with human epidermal growth factor receptor 2 status (p=0.044), whereas diffuse-type DM was significantly associated with a higher prevalence of the luminal-like subtype (p=0.048) and the presence of skull metastasis (p=0.002). Patients with diffuse DM did not exhibit a significant difference in OSDM but had a notably shorter interval from DM to LMC compared to those with nodular DM (p=0.049).
Conclusion
While the impact of DM on the overall prognosis of patients with BRCA is minimal, our findings underscore distinct characteristics and prognostic outcomes within DM subgroups.

Keyword

Brain metastasis; Breast neoplasms; Dural metastasis; Hormone receptor?positive status; Metastasis; Prognosis; Retrospective studies

Figure

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  Fig. 1. Flow chart of patient enrollment. BPM, brain parenchymal metastasis.

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  Fig. 2. Representative cases of nodular (A, B) and diffuse types of dural metastasis (C, D). (A) Nodular type of dural metastasis in left occipito-temporal region on T2-weighted image (T2WI) (arrowhead). (B) Dural tail was noted on contrast enhanced T1-weighted image (CE-T1WI) (arrows) accompanied by nodular dural metastasis (arrowhead). (C) Bone metastasis in left frontal bone on T2WI (double arrows). (D) Diffuse type of dural metastasis observed on CE-T1WI (dotted arrows).

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  Fig. 3. Overall survival after brain metastasis (with BPM alone vs. with DM). BPM, brain parenchymal metastasis; DM, dural metastasis.

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  Fig. 4. Prognostic analysis between subtypes of dural metastasis (DM). (A) Overall survival between subtypes of DM. (B) Leptomeningeal carcinomatosis–free survival between subtypes of DM.

Reference

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