To the Editor.—
As Wittes and Yeh (238:506-507, 1977) indicate, evaluation for brain and liver metastasis remains imprecise when histological confirmation is not obtained. Hansen and Muggia1 identified liver metastases by peritoneoscopy in one of six patients with small cell cancer who were thought not to have liver metastasis based on clinical evaluation and scan.While histological confirmation of suspected intracranial metastasis is not presently feasible, computerized tomographic brain scanning has provided important information with regard to the false positivity rate of isotope brain scans. In our series of 47 ambulatory patients with small cell lung cancer, one patient had clinical isotopic and computerized tomographic data consistent with brain metastasis. However, three other patients, each of whom had a definite focal abnormality on multiple views of the isotopic brain scan study and who were also studied by computerized tomographic brain scan, did not show edema or enhancement, but rather
Kane RC. Brain Scans for Metastasis. JAMA. 1978;239(20):2115–2116. doi:10.1001/jama.1978.03280470027011
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