Perineural spread to the brachial plexus: a focused review of proposed mechanisms and described pathologies

Murthy, Nikhil K.; Amrami, Kimberly K.; Spinner, Robert J.

doi:10.1007/s00701-020-04466-8

Cited by 9 publications

(6 citation statements)

References 57 publications

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“…We discovered perineural spread along extensive neural highways from malignant peripheral nerve sheath tumors (MPNSTs) (Gilder et al, 2018;Puffer et al, 2018), neurolymphomatosis (Capek et al, 2015c;Crush et al, 2014;DeVries et al, 2019;Ghobrial et al, 2004;Khurana et al, 2021;Murthy et al, 2020;Murthy et al, 2020a;Puffer et al, 2019), neuroleukemiosis (Reddy et al, 2012), and Pancoast tumors or other lesions invading into the brachial plexus (Murthy et al, 2020b). Furthermore, infectious etiologies, including mucormycosis or herpes zoster, also use these neural pathways for perineural spread.…”

Section: Highway II From Organ To Nerve and Beyond: Perineural Spread Is A Relatively Common Yet Under-recognized Pathway Of Metastatic Dmentioning

confidence: 99%

A novel mechanism for the formation and propagation of neural tumors and lesions through neural highways

Spinner

2021

Clinical Anatomy

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By recognizing anatomic and radiologic patterns of rare and often misdiagnosed peripheral nerve tumors/lesions, we have defined mechanisms for the propagation of neural diseases. The novel concept of the nervous system serving as a complex system of "highways" driving the neural and perineural spread of these lesions is described in three examples: Intraneural dissection of joint fluid in intraneural ganglion cysts, perineural spread of cancer cells, and dissemination of unknown concentrations of neurotrophic/inhibitory factors for growth in hamartomas/choristomas of nerve. Further mapping of these pathways to identify the natural history of diseases, the spectrum of disease evolution, the role of genetic mutations, and how these neural pathways interface with the lymphatic, vascular, and cerebrospinal systems may lead to advances in targeted treatments.

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Section: Highway II From Organ To Nerve and Beyond: Perineural Spread Is A Relatively Common Yet Under-recognized Pathway Of Metastatic Dmentioning

confidence: 99%

A novel mechanism for the formation and propagation of neural tumors and lesions through neural highways

Spinner

2021

Clinical Anatomy

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“…In advanced stages, the disease can cause neuropathic pain and functional impairment of the affected cranial nerves (CNs), leading to significant morbidity [ 6 ]. PNS is most common in adenoid cystic carcinoma (ACC) of the salivary glands and in squamous cell carcinoma (SCC), with reported prevalences of up to 56% and 34%, respectively, followed by mucoepidermoid carcinoma, desmoplastic melanoma, lymphoma, and sarcoma [ 2 , 3 , 7 , 8 , 9 , 10 , 11 ]. Because of the extensive innervation in the head and neck region, trigeminal and facial nerves are most often afflicted by PNS [ 3 , 5 , 9 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although in some studies, MRI showed high sensitivity and specificity in determining PNS [ 19 , 20 , 21 ], sampling bias could influence the false negative and false positive results and diagnostic accuracy of the studies. PNS must be differentiated from reactive or inflammatory nerve swelling and radiation-induced neuritis [ 10 , 21 ]. If only histologically confirmed cases with PNS are included in the study, specificity cannot be precisely assessed [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of MRI in Detecting the Perineural Spread of Head and Neck Tumors: A Systematic Review and Meta-Analysis

Abdullaeva,

Pape,

Hirvonen

2024

Diagnostics

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The purpose of this study was to review the diagnostic accuracy of MRI in detecting perineural spreading (PNS) of head and neck tumors using histopathological or surgical evidence from the afflicted nerve as the reference standard. Previous studies in the English language published in the last 30 years were searched from PubMed and Embase databases. We included studies that used magnetic resonance imaging (MRI) (with and without contrast enhancement) to detect PNS, as well as the histological or surgical confirmation of PNS, and that reported the exact numbers of patients required for assessing diagnostic accuracy. The outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Heterogeneity was assessed with the Higgins inconsistency test (I2). P-values smaller than 0.05 were considered statistically significant. A total of 11 retrospective studies were found, reporting 319 nerve samples from 245 patients. Meta-analytic estimates and their 95% confidence intervals were as follows: sensitivity 0.85 (0.70–0.95), specificity 0.85 (0.80–0.89), PPV 0.86 (0.70–0.94), and NPV 0.85 (0.71–0.93). We found statistically significant heterogeneity for sensitivity (I2 = 72%, p = 0.003) and PPV (I2 = 70%, p = 0.038), but not for NPV (I2 = 65%, p = 0.119) or specificity (I2 = 12%, p = 0.842). The most frequent MRI features of PNS were nerve enlargement and enhancement. Squamous cell carcinoma and adenoid cystic carcinoma were the most common tumor types, and the facial and trigeminal nerves were the most commonly affected nerves in PNS. Only a few studies provided examples of false MRI diagnoses. MRI demonstrated high diagnostic accuracy in depicting PNS of cranial nerves, yet this statement was based on scarce and heterogeneous evidence.

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“…This phenomenon has been well described in both the brachial and lumbosacral plexus. [9][10][11][12][13][14][15][16][17][18][19][20][21] The breast itself has a complex innervation pattern with multiple motor nerves deep to the breast tissue and sensory nerves superficially. 22 Most of the sensory innervation of the breast arises from the anterolateral and anteromedial branches of T3-5.…”

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confidence: 99%

The spectrum of brachial plexopathy from perineural spread of breast cancer

Jack

Smith

Capek

et al. 2022

Journal of Neurosurgery

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OBJECTIVE Perineural spread of breast cancer to the brachial plexus can lead to pain, sensory alterations, and upper-extremity weakness. Although rare, perineural spread is an often-misdiagnosed long-term complication following breast cancer diagnosis. The objective of this study was to critically review the clinical, radiological, and pathological findings of biopsy-proven perineural spread of breast cancer to the brachial plexus. METHODS This is a retrospective study from a single institution in which a total of 19 patients with brachial plexus involvement from perineural spread of breast cancer who underwent fascicular biopsy between 1999 and 2021 were identified. Clinical, radiographic, and pathological data were retrospectively collected. Descriptive statistics were calculated for the cohort. RESULTS The mean age of patients at the time of diagnosis of breast cancer perineural spread was 60.6 ± 11.5 years. The diagnosis of brachial plexopathy due to perineural spread was on average 12 years after the primary diagnosis of breast cancer. There was also a delay in diagnosis due to the rarity of this disease, with a mean time from initial symptom onset to diagnosis of perineural spread of 25 ± 30 months. All patients at the time of presentation had upper-extremity weakness and pain. Nearly all patients demonstrated T2 signal change and nodular so-called sugar-coating contrast enhancement on brachial plexus MRI. Similarly, all patients who underwent PET/MRI or PET/CT had increased FDG uptake in the involved brachial plexus. Breast cancer perineural spread has an overall poor prognosis, with 16 of 19 patients dying within 5.9 ± 3.0 years after diagnosis of perineural spread. CONCLUSIONS Perineural spread should be considered in patients with a history of breast cancer, even 10 years after primary diagnosis, especially in patients who present with arm pain, weakness, and/or sensory changes. Further diagnostic workup with electrodiagnostic studies; brachial plexus MRI, PET/CT, or PET/MRI; and possibly nerve biopsy is warranted to ensure accurate diagnosis.

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Perineural spread to the brachial plexus: a focused review of proposed mechanisms and described pathologies

Cited by 9 publications

References 57 publications

A novel mechanism for the formation and propagation of neural tumors and lesions through neural highways

A novel mechanism for the formation and propagation of neural tumors and lesions through neural highways

Diagnostic Accuracy of MRI in Detecting the Perineural Spread of Head and Neck Tumors: A Systematic Review and Meta-Analysis

The spectrum of brachial plexopathy from perineural spread of breast cancer

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