Recommendation Regarding Brain Imaging in Lung Cancer Staging

Recommendation Regarding Brain Imaging in Lung Cancer Staging

Background

Brain imaging is an important component of the accurate staging of newly diagnosed patients with non-small cell and small cell lung cancer. However, there is a paucity of robust evidence in the literature to give guidance as to the best imaging modality and those that should have brain imaging performed. Most recommendations come from large professional bodies such as NCCN, ESMO, NICE and the ACCP. Brain MRI is generally felt to be the most accurate modality. CT is an acceptable alternative if access to MRI is not possible or if there would be considerable delay in patient workup if waiting for an MRI to be completed.

Recommendation

Based on a review of the most recent guidelines from the organizations noted above:

  • Brain imaging is absolutely recommended for:
    • Patients with Clinical Stage III and IV NSCLC
    • Patients with symptoms (H/A, slurred speech etc…)
    • Patients with Small Cell Lung Cancer
  • Brain imaging for clinical Stage II NSCLC continues to be a matter of debate, however some national bodies have recommended it particularly NCCN.
  • MRI is the modality of choice over CT but depends on availability, wait time and cost.

Suggested Reading List

National Comprehensive Cancer Network (NCCN) – Clinical Practice Guidelines in Oncology, Non-Small Cell Lung Cancer v6.2018. http://www.nccn.org/default.aspx

National Institute for Health and Care Excellence (NICE) – Lung cancer: diagnosis and management (2011) NICE guideline CG121. https://pathways.nice.org.uk/pathways/ lung-cancer

Silvestri G. et. al., Methods for Staging Non-small Cell Lung Cancer.

Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2013; 143(5) (Suppl):e211S–e250S.

ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Early and locally advanced non-small-cell lung cancer (NSCLC). Ann Oncol (2017) 28 (suppl 4): iv1–iv21

Vernon J, Andruszkiewicz N, Schneider L, Schieman C, Finley CJ, Shargall Y, Fahim C, Farrokhyar F, Hanna WC. Comprehensive clinical staging for resectable lung cancer: Clinico-pathological correlations and the role of brain imaging. J Thorac Oncol. 2016 Nov;11(11):1970-1975