Brain Imaging for Staging of Patients With Clinical Stage IA Non-small Cell Lung Cancer in the National Lung Screening Trial

Balekian, Alex; Fisher, Joshua; Gould, Michael K.

doi:10.1378/chest.15-1140

Cited by 33 publications

(38 citation statements)

References 11 publications

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“…Thus, the potential gain from more sensitive brain imaging, such as MRI or contrast-enhanced CT of the brain, is uncertain. Furthermore, recent American guidelines have suggested not offering brain imaging to patients with early-stage disease due to a low incidence of brain metastases identified when patients with stage IA tumours were imaged as part of their diagnostic work up [11]. However, of 18 patients identified in our study, four had pathological stage-IA disease at the time of surgery, these patients generally had a longer interval from surgery to detection.…”

Section: Discussionmentioning

confidence: 86%

“…Secondly, for a small proportion of patients, the detection of their metastatic disease, particularly if oligometastatic disease within the central nervous system (CNS) allowed more aggressive treatment options in the form of surgery or stereotactic radiotherapy to the brain metastases. There is in fact growing evidence that resection of brain metastases improves survival outcomes in tumours with low-volume extracranial cancer [11, 15] with five-year survival rates up to 21% for patients who have had radical treatment of their brain metastases either with surgery or with stereotactic radiotherapy. The use of MRI brain to detect occult brain metastases provides not only an opportunity to treat oligometastatic disease, but studies have also reported improved survival in those with a good performance status at the time of diagnosis [15].…”

Section: Discussionmentioning

confidence: 99%

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Brain imaging before primary lung cancer resection: a controversial topic

Hudson¹,

Internullo²,

Edey³

et al. 2017

ecancer

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ObjectiveInternational and national recommendations for brain imaging in patients planned to undergo potentially curative resection of non-small-cell lung cancer (NSCLC) are variably implemented throughout the United Kingdom [Hudson BJ, Crawford MB, and Curtin J et al (2015) Brain imaging in lung cancer patients without symptoms of brain metastases: a national survey of current practice in England Clin Radiol https://doi.org/10.1016/j.crad.2015.02.007]. However, the recommendations are not based on high-quality evidence and do not take into account cost implications and local resources. Our aim was to determine local practice based on historic outcomes in this patient cohort.MethodsThis retrospective study took place in a regional thoracic surgical centre in the United Kingdom. Pathology records for all patients who had undergone lung resection with curative intent during the time period January 2012–December 2014 were analysed in October 2015. Electronic pathology and radiology reports were accessed for each patient and data collected about their histological findings, TNM stage, resection margins, and the presence of brain metastases on either pre-operative or post-operative imaging. From the dates given on imaging, we calculated the number of days post-resection that the brain metastases were detected.Results585 patients were identified who had undergone resection of their lung cancer. Of these, 471 had accessible electronic radiology records to assess for the radiological evidence of brain metastases. When their electronic records were evaluated, 25/471 (5.3%) patients had radiological evidence of brain metastasis. Of these, five patients had been diagnosed with a brain metastasis at initial presentation and had undergone primary resection of the brain metastasis followed by resection of the lung primary. One patient had been diagnosed with both a primary lung and a primary bowel adenocarcinoma; on review of the case, it was felt that the brain metastasis was more likely to have originated from the bowel cancer. One had been clinically diagnosed with a cerebral abscess while the radiology had been reported as showing a metastatic deposit. Of the remaining 18/471 (3.8%) patients who presented with brain metastases after their surgical resection, 12 patients had adenocarcinoma, four patients had squamous cell carcinoma, one had basaloid, and one had large-cell neuroendocrine. The mean number of days post-resection that the brain metastases were identified was 371 days, range 14–1032 days, median 295 days (date of metastases not available for two patients).ConclusionThe rate of brain metastases identified in this study was similar to previous studies. This would suggest that preoperative staging of the central nervous system may change the management pathway in a small group of patients. However, for this group of patients, the change would be significant either sparing them non-curative surgery or allowing aggressive management of oligometastatic disease. Therefore, we would recommend pre-operative brain imagin...

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Brain imaging before primary lung cancer resection: a controversial topic

Hudson¹,

Internullo²,

Edey³

et al. 2017

ecancer

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show abstract

“…The date of staging completion (Sx) was the earliest date when both radiological and pathologic confirmation of the cancer stage was finalized. This included brain imaging when indicated by the National Comprehensive Cancer Network (NCCN) guidelines [8]. The date of pd-MTB note was identified by chart review.…”

Section: Methodsmentioning

confidence: 99%

Pre-diagnosis Multidisciplinary Tumor Board and Time to Staging in Lung Cancer: The Case Western MetroHealth Experience

Muthukrishnan¹,

Ratnam²,

Nguyen³

et al. 2020

Cureus

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Introduction National guidelines support the discussion of cancer patients by multidisciplinary tumor boards (MTB). We researched whether early pre-diagnosis multidisciplinary tumor board discussions are associated with shorter times to staging in lung cancer. Methods We reviewed our institution's lung cancer and MTB registries to retrospectively study if an early discussion at pre-diagnostic MTB (pd-MTB) influenced the timeliness of diagnostic evaluation. Over 14 months, 161 consecutive patients with a diagnosis of lung cancer were included. Fiftyfive patients were presented at pd-MTB while 106 (controls) patients were not. The primary outcome was the difference in the time interval from suspicious imaging (Ix) to completion of staging (Sx). Outcomes were adjusted for key confounders with a multiple regression analysis. Results For stages I, II, and III lung cancer, where time to therapy matters, early discussion of patients with nodules suspicious for malignancy at pd-MTB was associated with no time delays when compared to patients who were not discussed in pd-MTB. The mean time intervals for imaging to staging (with standard deviations) are 65 days in controls (sd = 42.67) and 75 days (sd = 58.27) in tumor board cases (p=0.39). Adjusting for confounders with a multiple regression analysis among all stages revealed a similar lack of difference in time intervals to diagnosis, staging, and therapy.

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“…These studies were predominantly retrospective, however, and the guidelines correctly note that the use of routine MRI in staging disease in patients with NSCLC and negative clinical evaluations has not been sufficiently studied. [2][3][4] In this issue of CHEST (see page 943), Balekian et al 5 provide additional data on the use of brain imaging for patients with clinical stage IA disease that is detected as part of a lung cancer screening program. The investigators conducted a secondary analysis of data collected as part of the National Lung Screening Trial.…”

mentioning

confidence: 99%

“…However, it is possible that in certain well-defined populations, the NPV of a clinical evaluation, given a very low pretest probability, is sufficient to make brain imaging unnecessary. Balekian et al 5 identified a low pretest probability group (ie, screen-detected clinical stage I NSCLC) that meets these criteria. Based on the data presented (as well as on previously published data), it seems reasonable to recommend foregoing brain imaging in asymptomatic patients with screen-detected clinical stage I NSCLC.…”

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confidence: 99%

Wise Choices to Improve the Quality of Lung Cancer Care

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2016

Chest

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Brain Imaging for Staging of Patients With Clinical Stage IA Non-small Cell Lung Cancer in the National Lung Screening Trial

Cited by 33 publications

References 11 publications

Brain imaging before primary lung cancer resection: a controversial topic

Brain imaging before primary lung cancer resection: a controversial topic

Pre-diagnosis Multidisciplinary Tumor Board and Time to Staging in Lung Cancer: The Case Western MetroHealth Experience

Wise Choices to Improve the Quality of Lung Cancer Care

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