Frequency of asymptomatic choroidal metastasis in patients with disseminated breast cancer: results of a prospective screening programme

Abstract

Aim-To determine the frequency of visually asymptomatic choroidal metastasis in patients with disseminated breast cancer and its dependence on the incidence of metastasis by number and site of other organ metastases. Methods-From January 1995 until April 1997 120 patients irradiated for disseminated breast cancer underwent ophthalmological screening for choroidal metastasis. No patient was symptomatic for ocular disease. 68 out of 120 patients were found to have metastases in one organ and 52 patients had metastases in more than one organ. 80% of the patients had bone metastases, 25% lung metastases, 22% liver metastases, 15% brain metastases, and 22% had metastases in other organs. Results-Six patients (5%) were found to have asymptomatic choroidal metastases. Five patients had unilateral and one patient bilateral metastases. 52 patients with more than one involved organ had a significantly higher risk for asymptomatic choroidal metastasis (6/52, 11%) than 68 patients with metastases in only one organ (0/68) (p=0.006). In univariate analysis a significantly higher risk was seen for patients with lung metastases (14% choroidal metastases versus 2% in patients without lung metastases, p=0.03) and for patients with brain metastases (17% choroidal metastases versus 3% in those without brain metastases, p=0.04). Conclusion-In disseminated breast cancer the incidence of asymptomatic choroidal metastases was 5% and increased to 11% when more than one organ was involved in metastatic spread. Risk factors for choroidal metastases were dissemination of disease in more than one organ and the presence of lung and brain metastases.

Screening for ophthalmic involvement in asymptomatic patients with metastatic breast carcinoma

“…The fact that no case demonstrated uveal metastases in our study might have been accounted for by treatment with chemotherapy or hormonal therapy for metastatic disease, which may possibly have caused regression of uveal metastases. In a study by Wiegel et al, 8 patients with metastases from breast carcinoma in more than one organ and specifically with lung and brain metastases had a significantly higher risk of choroidal metastases compared with patients with only one site of metastases. The incidence of choroidal metastases in their group was 7% (6/120) and increased to 11% when there was more than one site of metastases.…”

Uveal metastatic disease: Current and new treatment options (Review)

“…Uveal metastasis is the most common malignancy of the eye (5,9,23). Early detection and treatment may help avoid significant visual loss and in some cases may even aid in making the primary diagnosis.…”

“…Although most of the patients remain asymptomatic (5)(6)(7)25), whenever symptoms appear the most common complaint is blurred vision (2,5,7,22,26). In cases of choroidal metastasis, the blurring may be secondary to macular involvement or the presence of subretinal fluid that may compromise the fovea (9).…”

“…Some lesions may show the so-called 'leopard skin' appearance due to the brown pigmentation on their surface secondary to lipofuscincontaining macrophages. In up to 1/3 of the cases, the affected eye may present with more than one focus of metastasis and up to 50% of patients may have bilateral involvement (5,20,23,26) (Fig. 2).…”

“…The prevalence of uveal metastasis from all forms of carcinomas varies from 2.3 to 9.2% in the published series with breast cancer being the most common primary site followed by lung cancer (2,5,9). Other sites of primary malignancies are the kidney, thyroid, prostate, pancreas, testis and other organs (14-19).…”