Navigating Diagnostic Challenges: Leptomeningeal Metastasis in Triple-Negative Breast Cancer - A Study Emphasizing the Interplay of Clinical Evaluation, Neuroimaging, and Cerebrospinal Fluid Analysis

Abstract

Background: Triple Negative Breast Cancer (TNBC) is known for its aggressive nature and limited treatment options. Among its complications, neurological symptoms, including leptomeningeal metastasis, pose significant clinical challenges. This study aims to investigate the clinical presentation, radiological findings, treatment responses, and outcomes in TNBC patients presenting with neurological symptoms.

Methodology: An observational descriptive study was conducted, including ten female patients aged 47 to 60 years with TNBC. Clinical presentations were assessed alongside diagnostic findings from immunohistochemistry, metastasis evaluations, and neurological symptomatology. Treatment responses were evaluated through changes in breast lump size, lymph node involvement, MRI brain findings, and CSF cytology across chemotherapy cycles.

Results: All patients showed a good systemic response to neoadjuvant chemotherapy with Docetaxel and Carboplatin, evidenced by the reduction and resolution of breast lumps and supraclavicular lymph node involvement. However, neurological symptoms persisted or worsened in some cases, with MRI brain findings evolving from FLAIR hyperintensities to increased sulcal and leptomeningeal enhancement, indicating progressive neurological involvement. CSF cytology turned positive for tumor cells by the end of the treatment cycle in some patients, highlighting the challenge of managing leptomeningeal metastasis in TNBC.

Conclusion: While TNBC patients can respond well to systemic chemotherapy, neurological complications remain a significant challenge, suggesting a multifactorial nature of neurological involvement. This study underscores the need for early detection, more effective treatment strategies targeting both systemic disease and neurological complications, and further research into the underlying mechanisms and potential biomarkers for early intervention.