Computed Tomographic Scanning of the Brain in Initial Staging of Bronchogenic Carcinoma

Hooper, Robert G.; Tenholder, Michael F.; Underwood, George H.; Beechler, Cash R.; Spratling, Larry

doi:10.1378/chest.85.6.774

Cited by 72 publications

(38 citation statements)

References 5 publications

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“…The incidence of brain metastases in the initial staging of patients with primary lung cancer has been reported to be between 12% and 18% (15,16). Also in our study, 12 % of the patients with a lung tumour had brain metastases.…”

supporting

confidence: 69%

Staging of lung cancer. do we need a diagnostic ct of the brain after an integrated pet/ct for the detection of brain metastases?

Wever¹,

Bruyeer²,

Demaerel³

et al. 2010

Journal of the Belgian Society of Radiology

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Brain CT has been recommended in staging of patients with lung cancer because of its usefulness in the detection of metastases. Purpose of this study is to examine if a diagnostic brain CT (CT1) can be obviated when an integrated PET/CT (PET/CT ) is available. 87 consecutive patients underwent a diagnostic brain CT and a whole-body PET/CT within a period of 3 weeks to stage a known primary tumour. CT examinations were evaluated by two experienced neuroradiologists on the detection of brain lesions (benign and malignant). The results of PET/CT and CT reading were compared and both readings were compared with the clinical results. Statistical analysis was done by measuring sensitivity, specificity, PPV, NPV and accuracy. The relative accuracies were compared by a McNemar (exact) test for correlated proportions. Considering the CT1 as standard of reference, sensitivity, specificity, PPV, NPV and accuracy for the brain CT of PET/CT (CT2) and PET/CT were respectively 83%, 96%, 77%, 97%, 94% and 69%, 98%, 90%, 95%, 94%. Considering the clinical diagnosis as standard of reference these figures were for CT1, CT2 and PET/CT respectively 80%, 100%, 100%, 96%, 96% and 66%, 95%, 77%, 93%, 90% and 66%, 97%, 83%, 93%, 91%. There was no statistical difference between CT1 and CT2. The comparison of the additional CT in PET/CT with a diagnostic CT of the brain did not yield a statistical difference in the detection of brain lesions despite the inferior quality of the CT component of PET/CT. A diagnostic brain CT can be obviated when a PET/CT is available.

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supporting

confidence: 69%

Staging of lung cancer. do we need a diagnostic ct of the brain after an integrated pet/ct for the detection of brain metastases?

Wever¹,

Bruyeer²,

Demaerel³

et al. 2010

Journal of the Belgian Society of Radiology

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“…The absence of neurologic symptoms did not exclude brain metastases since 64% of patients with metastases detected by CT were asymptomatic. Conversely, Hooper et al 19 found that CT scans did not reveal unsuspected brain metastases in patients without strong evidence of disseminated disease, such as neurologic signs or symptoms, bone pain, or elevated serum calcium. Hooper et al 19 did not address the utility of CT scans in otherwise operable patients, and it is possible that their patient group had a more advanced stage of disease at presentation than that seen by Ferrigno and Buccheri, 18 which would account for the different conclusions reached by the two authors.…”

Section: Ct/mrimentioning

confidence: 97%

ACR Appropriateness Criteria^® Pre-Irradiation Evaluation and Management of Brain Metastases

Gore

Bradley

et al. 2014

Journal of Palliative Medicine

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Pretreatment evaluation is performed to determine the number, location, and size of the brain metastases and magnetic resonance imaging (MRI) is the recommended imaging technique, particularly in patients being considered for surgery or stereotactic radiosurgery. A contiguous thin-cut volumetric MRI with gadolinium with newer gadolinium-based agents can improve detection of small brain metastases. A systemic workup and medical evaluation are important, given that subsequent treatment for the brain metastases will also depend on the extent of the extracranial disease and on the age and performance status of the patient. Patients with hydrocephalus or impending brain herniation should be started on high doses of corticosteroids and evaluated for possible neurosurgical intervention. Patients with moderate symptoms should receive approximately 4-8 mg/d of dexamethasone in divided doses. The routine use of corticosteroids in patients without neurologic symptoms is not necessary. There is no proven benefit of anticonvulsants in patient without seizures. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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“…When present, skeletal or CNS metastases usually are associated with an abnormal examination or laboratory values [19,58,70]. For this reason, brain CT scans and radionuclide bone scans should be performed only for certain indications and not in every case.…”

Section: Brain and Bone Scansmentioning

confidence: 99%

Noninvasive clinical staging modalities for lung cancer

Lau

Harpole

2000

Sem. Surg. Onc.

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Computed Tomographic Scanning of the Brain in Initial Staging of Bronchogenic Carcinoma

Cited by 72 publications

References 5 publications

Staging of lung cancer. do we need a diagnostic ct of the brain after an integrated pet/ct for the detection of brain metastases?

Staging of lung cancer. do we need a diagnostic ct of the brain after an integrated pet/ct for the detection of brain metastases?

ACR Appropriateness Criteria^® Pre-Irradiation Evaluation and Management of Brain Metastases

Noninvasive clinical staging modalities for lung cancer

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Computed Tomographic Scanning of the Brain in Initial Staging of Bronchogenic Carcinoma

Cited by 72 publications

References 5 publications

Staging of lung cancer. do we need a diagnostic ct of the brain after an integrated pet/ct for the detection of brain metastases?

Staging of lung cancer. do we need a diagnostic ct of the brain after an integrated pet/ct for the detection of brain metastases?

ACR Appropriateness Criteria® Pre-Irradiation Evaluation and Management of Brain Metastases

Noninvasive clinical staging modalities for lung cancer

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Product

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ACR Appropriateness Criteria^® Pre-Irradiation Evaluation and Management of Brain Metastases