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.

Recommendation Regarding Brain Imaging in Lung Cancer Staging