Role of Pre-Operative Brain Imaging in Patients with NSCLC Stage I: A Retrospective, Multicenter Analysis

Abstract

Background: Lung cancer is the worldwide leading oncological cause of death in both genders combined and accounts for around 40–50% of brain metastases in general. In early-stage lung cancer, the incidence of brain metastases is around 3%. Since the early detection of asymptomatic cerebral metastases is of prognostic value, the aim of this study was to analyze the incidence of brain metastases in early-stage lung cancer and identify possible risk factors. Methods: We conducted a retrospective multicentric analysis of patients with Stage I (based on T and N stage only) Non-Small Cell Lung Cancer (NSCLC) who had received preoperative cerebral imaging in the form of contrast-enhanced CT or MRI. Patients with a history of NSCLC, synchronous malignancy, or neurological symptoms were excluded from the study. Analyzed variables were gender, age, tumor histology, cerebral imaging findings, smoking history, and tumor size. Results were expressed as mean with standard deviation or median with range. Results: In total, 577 patients were included in our study. Eight (1.4%) patients were found to have brain metastases in preoperative brain imaging. Tumor histology was adenocarcinoma in all eight cases. Patients were treated with radiotherapy (five), surgical resection (two), or both (one) prior to thoracic surgical treatment. Other than tumor histology, no statistically significant characteristics were found to be predictive of brain metastases. Conclusion: Given the low incidence of brain metastases in patients with clinical Stage I NSCLC, brain imaging in this cohort could be avoided.

Brain metastasis screening in the molecular age

“…8–11 While there are ongoing clinical studies investigating the role of BM screening in HR+, HER2+, TN, and inflammatory breast cancers, to date data are conflicting and require further investigation. 44 , 45 Due to a relative paucity of data, further clinical trials incorporating molecular data into screening guidelines for BM are necessary to rigorously evaluate the benefits of molecular-based BM screening recommendations. The absence of guidelines for follow-up imaging for asymptomatic breast cancer and NSCLC patients after an initial negative MRI highlights the need for more research in this area, especially as many patients who are initially negative for BM go on to develop BM later in the disease course.…”

“… 44 That said, studies of stage I NSCLC undergoing brain imaging with CT and/or MRI prior to lung disease resection, found that the incidence of asymptomatic BM amongst these patients (1.4%–2.4%) was too low to justify routine screening. 44 , 45 As a result, preoperative brain imaging for stage II NSCLC patients undergoing surgical resection of their disease is recommended as these patients can have concurrent asymptomatic BM. 46 …”

Role of Contrast-Enhanced MRI in Diagnosing Brain Metastases in Patients With Lung Cancer

“…Рак легкого -одно из самых распространенных в мировой популяции злокачественных новообразований. В случае рака легкого около 40% всех метастазов приходится на головной мозг, которые на ранних стадиях заболевания возникают примерно у 3% пациентов [1]. Не только своевременность, но и качество диагностики напрямую влияют на выживаемость больных и качество их жизни.…”