What is the role of lab testing in the workup of brain metastasis?

Updated: Aug 01, 2018
  • Author: Victor Tse, MD, PhD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

Laboratory investigations include blood work, such as CBC, electrolyte panel, coagulation screen, and liver function panel.

Specific markers, such as anti-Hu antibody in limbic encephalopathy, anti-Yo antibody in cerebellar degeneration, and anti-Ri antibody in opsoclonus and ataxia are of some value, especially in patients with small-cell lung cancer, ovarian cancer, and breast or lung cancers.

Chronic anemia is common in systemic disease.

Electrolyte imbalance, such as in hyponatremia (hypothyroidism or syndrome of inappropriate secretion of antidiuretic hormone [SIADH]), can be found in patients with metastasis to the pituitary gland and meninges.

Abnormal coagulopathy can be observed in patients with breast cancer or leukemia.

Abnormal liver function is common in patients with advanced systemic diseases or in those receiving chemotherapy.

Specific markers, such as anti-Hu antibody in limbic encephalopathy, anti-Yo antibody in cerebellar degeneration, and anti-Ri antibody in opsoclonus and ataxia, are of some diagnostic value, especially in patients with small-cell lung cancer, ovarian cancer, breast cancer, or lung cancers.

The recent advancement in genomic and proteomic medicine allows the use of a molecular signature to gauge the risk of developing brain metastasis. For example, in young breast cancer patients, an ER-positive, PR-positive, and HER2 -negative profile incurs a higher brain metastasis risk compared with a triple-negative or HER2 -positive profile. [8] It is especially true if the patient has a short interval between initial diagnosis and systemic metastasis; this risk is noted to be even higher if there are multiple sites of systemic metastasis. In current practice, this is beginning to be used as a method to guide personalized therapy.


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