Preoperative brain MRI for clinical stage IA lung cancer: is routine scanning rational?

Haiquan Chen,David O. Wilson,Shanbo Zheng,Binhao Huang,Juntao Xie,Jie Zhang,Jiaqing Xiang,Yangle Huang,Shengfei Wang,Difan Zheng,Yue Zhao,Hengyu Mao,James D. Luketich,Lingdun Zhuge

doi:10.1007/s00432-018-2814-2

Abstract

PurposeEarly detection and control of lung cancer brain metastases (BMs) are important. However, several guideline recommendations are inconsistent with regard to routine preoperative brain MRI, especially in patients with clinical stage IA lung cancer. Our study evaluated the value of preoperative brain MRI in patients with clinical stage IA lung cancer.MethodsA retrospective analysis of patients with lung cancer was performed using a prospectively collected database. Clinical data and the results of brain MRI were collected and analyzed.ResultsPatients with pathologically proved primary lung cancer who underwent an MRI at initial diagnosis were identified (3392 patients). In total, 170 patients (5.0%) were diagnosed with BMs. The increased frequency of BMs was significantly associated with advanced clinical stage (P = 0.000) and pathological type (P = 0.011). BMs were detected in 11 out of 1595 patients with clinical stage IA lung cancer (0.7%). BMs were more common in patients with clinical stage cT1c lung cancer (1.9%) than those with clinical stage cT1a or cT1b (0.1%, odds ratio = 21.30, 95% confidence interval: 2.7–166.9, P = 0.000). All patients with stage IA lung cancer and BMs had solid lung lesions (P = 0.002).ConclusionsPreoperative brain MRI might help identify BMs in patients with lung cancer that has progressed beyond stage IA. In patients with clinical stage IA lung cancer, we do not recommend preoperative brain MRI, but it may potentially be beneficial in those with solid T1c cancers.

Highlights

Lung cancer is the leading cause of cancer-related death worldwide (Siegel et al 2014)
brain metastases (BMs) usually lead to higher mortality and decreased quality of life, with a median survival after diagnosis of less than 1 year.(Enders et al 2016; Penel et al 2001) It is estimated that 30–50% of lung cancer patients die from neurologic causes.(Nguyen and DeAngelis 2007) early detection and treatment of BMs is of great importance
Due to the extensive use of Magnetic resonance imaging (MRI) brain imaging prior to lung cancer resection at our institution, we were able to evaluate the value of preoperative brain MRI in a large cohort of patients with early stage lung cancer

Summary

Introduction

Lung cancer is the leading cause of cancer-related death worldwide (Siegel et al 2014). Detection of distant metastases when staging lung cancer is critical to avoid unnecessary surgery and initiate suitable multidisciplinary treatment. Several studies indicated that 10–36% of lung cancer patients developed brain metastases (BMs) over the course of the disease (Schouten et al 2002; Villano et al 2015). BMs usually lead to higher mortality and decreased quality of life, with a median survival after diagnosis of less than 1 year.(Enders et al 2016; Penel et al 2001) It is estimated that 30–50% of lung cancer patients die from neurologic causes.(Nguyen and DeAngelis 2007) early detection and treatment of BMs is of great importance. MRI brain imaging has a reported sensitivity and specificity of 97.7% and 100%, respectively.(Kim et al 2005) MRI brain imaging is superior to CT of the head for detection of small (< 1 cm) metastases, posterior fossa lesions, and multiple metastases (Purandare and Rangarajan 2015)

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