Brain imaging in early stage non-small cell lung cancer: still a controversial topic?

Schoenmaekers, Janna; Dingemans, Anne‐Marie C.; Hendriks, Lizza

doi:10.21037/jtd.2018.06.68

Cited by 12 publications

(8 citation statements)

References 24 publications

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“…This finding is consistent with prior reports, where the perceived risk of brain metastasis and subsequent impact to patient management is felt to be high enough to justify imaging despite guidelines. [ 24 25 26 27 ]…”

Section: Discussionmentioning

confidence: 99%

The effect of diagnostic assessment programs on the diagnosis and treatment of patients with lung cancer in Ontario, Canada

et al. 2021

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INTRODUCTION: Diagnostic assessment programs (DAPs) were implemented in Ontario, Canada, to improve the efficiency of the lung cancer care continuum. We compared the efficiency and effectiveness of care provided to patients in DAPs relative to usual care (non-DAPs). METHODS: Lung cancer patients diagnosed between 2014 and 2016 were identified from the Ontario Cancer Registry. Using administrative databases, we identified various health-care encounters 6 months before diagnosis until the start of treatment and compared utilization patterns, timing, and overall survival between DAP and non-DAP patients. RESULTS: DAP patients were younger ( P < 0.0001), had fewer comorbidities ( P = 0.0006), and were more likely to have early-stage disease (36% vs. 25%) than non-DAP patients. Although DAP patients had a similar time until diagnosis as non-DAP patients, the time until treatment was 8.5 days shorter for DAP patients. DAP patients were more likely to receive diagnostic tests and specialist consultations and less likely to have duplicate chest imaging. DAP patients were more likely to receive brain imaging. Among early-stage lung cancers, brain imaging was high (74% for DAP and 67% for non-DAP), exceeding guideline recommendations. After adjustment for clinical and demographic factors, DAP patients had better overall survival than non-DAP patients (hazard ratio [HR]: 0.79 [0.76–0.82]), but this benefit was lost after adjusting for emergency presentation (HR: 0.96 [0.92–1.00]). A longer time until treatment was associated with better overall survival. CONCLUSION: DAPs provided earlier treatment and better access to care, potentially improving survival. Quality improvement opportunities include reducing unnecessary or duplicate testing and characterizing patients who are diagnosed emergently.

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Section: Discussionmentioning

confidence: 99%

The effect of diagnostic assessment programs on the diagnosis and treatment of patients with lung cancer in Ontario, Canada

et al. 2021

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“…The screening modality used in our study was CECT with the limited use of MRI, which might have affected the sensitivity in detection of brain metastases. Schoenmaekers et al 11 have previously reported additional detection of brain metastasis in 4.7% of cases by MRI where CECT was negative. This would probably imply that CT scan is a good option as an initial screening modality as part of baseline staging where MRI could not be done in view of logistics and MRI can be preferred in highly suspicious CT-negative patients.…”

Section: Discussionmentioning

confidence: 97%

“…However, recommendations for baseline brain imaging particularly in patients with advanced NSCLC who are asymptomatic for brain metastases are weak and controversial. 11 – 13 There is a paucity of data regarding the exact frequency, risk factors, and clinicopathologic and molecular correlation of asymptomatic and symptomatic brain metastasis at presentation. Performing MRI for all the patients may not be feasible in resource-constraint settings like ours.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Brain Metastasis at Diagnosis in Non–Small-Cell Lung Cancer: A Prospective Observational Study From North India

Naresh

Malik

Khurana

et al. 2021

JCO Global Oncology

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PURPOSE The incidence of symptomatic brain metastasis at diagnosis in non–small-cell lung cancer (NSCLC) is 5%-10%, and up to 40% develop during the disease course. There is a paucity of data supporting the role of brain imaging at diagnosis in asymptomatic cases particularly from resource-constraint settings. Here, we present our experience of mandatory baseline brain imaging with contrast-enhanced computed tomography (CECT) scans of all patients with NSCLC. MATERIALS AND METHODS This was a prospective observation study of patients with NSCLC with mandatory baseline brain CECT and a CNS examination. All histology proven patients with NSCLC diagnosed between January 2018 and October 2019 were included irrespective of stage. RESULTS A total of 496 patients were enrolled. The median age was 57 years (range, 23-84) with majority being males (75%) and smokers (66%). The prevalence of epidermal growth factor receptor mutations and anaplastic lymphoma kinase fusions was 33.4% and 12%, respectively. Brain imaging leads to upstaging in 7% cases. The prevalence of brain metastases was 21% (n = 104), with half being asymptomatic (51%). Factors associated with higher proportion of brain metastasis were young age (≤ 40 years), adenocarcinoma histology, poor Eastern Cooperative Oncology Group performance status (3 and 4), and high neutrophil-lymphocyte ratio (NLR) (> 2.5). After a median follow-up of 10.8 months (95% CI, 7.33 to 12.73), the median overall survival was 7.46 versus 12.76 months (hazard ratio 0.67; 95% CI, 0.46 to 0.96; P = .03) in patients with and without brain metastases, respectively. On multivariate analyses, high NLR and molecular graded prognostic assessment affected the overall survival significantly. CONCLUSION In our study, 21% of patients had brain metastasis at diagnosis detected with a mandatory baseline brain imaging with CECT. NLR and molecular graded prognostic assessment are significant predictors of survival in patients with brain metastasis.

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“…Computed tomography (CT), magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) and positron emission tomography/computed tomography (PET/CT) are the common techniques to screen the distant metastasis in LC patients. However, routine DM screening to all LC patients is controversial because of low detection rate of asymptomatic patients, invasive operation, potential risk of adverse reactions, complex process and high cost (10)(11)(12)(13)(14). Therefore, there are strong requirements for the identification of a high-risk group with distant metastasis and the rationalization of DM screening in LC patients.…”

Section: Introductionmentioning

confidence: 99%

Machine Learning for the Prediction of Synchronous Organ-Specific Metastasis in Patients With Lung Cancer

Gao

et al. 2022

Front. Oncol.

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BackgroundThis study aimed to develop an artificial neural network (ANN) model for predicting synchronous organ-specific metastasis in lung cancer (LC) patients.MethodsA total of 62,151 patients who diagnosed as LC without data missing between 2010 and 2015 were identified from Surveillance, Epidemiology, and End Results (SEER) program. The ANN model was trained and tested on an 75/25 split of the dataset. The receiver operating characteristic (ROC) curves, area under the curve (AUC) and sensitivity were used to evaluate and compare the ANN model with the random forest model.ResultsFor distant metastasis in the whole cohort, the ANN model had metrics AUC = 0.759, accuracy = 0.669, sensitivity = 0.906, and specificity = 0.613, which was better than the random forest model. For organ-specific metastasis in the cohort with distant metastasis, the sensitivity in bone metastasis, brain metastasis and liver metastasis were 0.913, 0.906 and 0.925, respectively. The most important variable was separate tumor nodules with 100% importance. The second important variable was visceral pleural invasion for distant metastasis, while histology for organ-specific metastasis.ConclusionsOur study developed a “two-step” ANN model for predicting synchronous organ-specific metastasis in LC patients. This ANN model may provide clinicians with more personalized clinical decisions, contribute to rationalize metastasis screening, and reduce the burden on patients and the health care system.

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Brain imaging in early stage non-small cell lung cancer: still a controversial topic?

Cited by 12 publications

References 24 publications

The effect of diagnostic assessment programs on the diagnosis and treatment of patients with lung cancer in Ontario, Canada

The effect of diagnostic assessment programs on the diagnosis and treatment of patients with lung cancer in Ontario, Canada

Assessment of Brain Metastasis at Diagnosis in Non–Small-Cell Lung Cancer: A Prospective Observational Study From North India

Machine Learning for the Prediction of Synchronous Organ-Specific Metastasis in Patients With Lung Cancer

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