Comprehensive Clinical Staging for Resectable Lung Cancer: Clinicopathological Correlations and the Role of Brain MRI

Abstract

CCS is effective for patients with resectable lung cancer, with less than 5% of patients being denied appropriate systemic treatment before surgery. Brain MRI is a low-yield and high-cost intervention in this population, and its routine use should be questioned.

Should we screen for brain metastases in non‐small cell lung cancer?

“…report that occult brain metastases were only detected in 2.5% (18 patients), with isolated brain metastases in <1% (six patients). This is similar to the 1.3% detection rate of asymptomatic brain metastases on MRI reported in a Canadian study of operable NSCLC patients . Higher incidences of 7.8–9% are reported from cancer registries .…”

“…This is similar to the 1.3% detection rate of asymptomatic brain metastases on MRI reported in a Canadian study of operable NSCLC patients. 6 Higher incidences of 7.8-9% are reported from cancer registries. 7,8 However, these data are historical, in an era where brain MRI and PET CT would not have been routine.…”

“…The cost of brain screening in an unselected population is considerable . In the Canadian study, pre‐operative brain MRIs accounted for almost one‐third of staging costs .…”

“…1,6 In the Canadian study, pre-operative brain MRIs accounted for almost one-third of staging costs. 6 There is also the potential for harm with the risk of an adverse reaction to contrast and the potential delays in commencing treatment whilst waiting for results of diagnostic imaging. Diaz et al report that detection of asymptomatic brain metastases only changed management in less than one percent of cases (6/1751), who were spared the toxicities of local definitive therapy.…”

Screening for Brain Metastases in Resectable Non–Small Cell Lung Cancer

“…To the Editor: With interest we read the article of Vernon et al 1 As brain metastases are frequent in lung cancer, their aim to investigate the value of magnetic resonance imaging (MRI) of the brain in a comprehensive clinical staging (CCS) with computed tomography of the chest and upper abdomen, whole body positron emission tomography, and MRI of the brain is of interest. However, as they analyzed only patients with NSCLC who were operated on, we wonder whether their conclusion that brain MRI is a low-yield and high-cost intervention in this patient population is valid.…”