Diagnostic Yield of Staging Brain MRI in Patients with Newly Diagnosed Non-Small Cell Lung Cancer.

Background Existing guidelines are inconsistent regarding the indications for staging brain MRI in patients with newly diagnosed, early-stage non-small cell lung cancer (NSCLC). Purpose To evaluate the diagnostic yield of staging brain MRI in the initial evaluation of lung cancer. Materials and Methods This retrospective, observational, single-institution study included patients with newly diagnosed NSCLC who underwent staging chest CT and staging brain MRI from November 2017 to October 2018. Diagnostic yield was defined as the proportion of patients with brain metastases among all patients. Yield was stratified into clinical stage groups per the eighth edition of the American Joint Committee on Cancer staging guidelines, based on staging chest CT and in adenocarcinoma with epidermal growth factor receptor (EGFR) gene mutation and anaplastic lymphoma kinase (ALK) gene rearrangement. Subgroup analyses were performed on the basis of cell types and molecular markers. The χ2 test was performed to compare the diagnostic yields, and Bonferroni correction was used to account for multiple testing between stage groups. Results A total of 1712 patients (mean age, 64 years ± 10 [standard deviation]; 1035 men) were included. The diagnostic yield of staging brain MRI in newly diagnosed NSCLC was 11.9% (203 of 1712; 95% confidence interval [CI]: 10.4%, 13.5%). In clinical stage IA, IB, and II disease, the diagnostic yields were 0.3% (two of 615; 95% CI: 0.0%, 1.2%), 3.8% (seven of 186; 95% CI: 1.5%, 7.6%), and 4.7% (eight of 171; 95% CI: 2.0%, 9.0%), respectively. The diagnostic yield was higher in patients with adenocarcinoma (13.6%; 176 of 1297; 95% CI: 11.8%, 15.6%) than squamous cell carcinoma (5.9%; 21 of 354; 95% CI: 3.7%, 8.9%) and in patients with EGFR mutation-positive adenocarcinoma (17.5%; 85 of 487; 95% CI: 14.2%, 21.1%) than with EGFR mutation-negative adenocarcinoma (10.6%; 68 of 639; 95% CI: 8.4%, 13.3%) (P < .001 for both). Conclusion The diagnostic yield of staging brain MRI in clinical stage IA non-small cell lung cancer was low, but staging brain MRI had a higher diagnostic yield in clinical stage IB and epidermal growth factor receptor mutation-positive adenocarcinoma. © RSNA, 2020 Online supplemental material is available for this article.

[1]  Huijuan Wang,et al.  Driver genes as predictive indicators of brain metastasis in patients with advanced NSCLC: EGFR, ALK, and RET gene mutations , 2019, Cancer medicine.

[2]  Gretchen Hermann,et al.  EGFR mutant locally advanced non-small cell lung cancer is at increased risk of brain metastasis , 2019, Clinical and translational radiation oncology.

[3]  Y. Amano,et al.  Early stage non-small cell lung cancer patients need brain imaging regardless of symptoms , 2018, International Journal of Clinical Oncology.

[4]  Eudocia Q Lee,et al.  Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study , 2017, Neuro-oncology.

[5]  Yi-long Wu,et al.  Leptomeningeal Metastases in Patients with NSCLC with EGFR Mutations , 2016, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[6]  F. Farrokhyar,et al.  Comprehensive Clinical Staging for Resectable Lung Cancer: Clinicopathological Correlations and the Role of Brain MRI , 2016, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[7]  K. Kim,et al.  The detectability of brain metastases using contrast-enhanced spin-echo or gradient-echo images: a systematic review and meta-analysis , 2016, Journal of Neuro-Oncology.

[8]  S. J. Henley,et al.  Patterns in lung cancer incidence rates and trends by histologic type in the United States, 2004-2009. , 2014, Lung cancer.

[9]  L. Tanoue,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. , 2013, Chest.

[10]  A. Twijnstra,et al.  Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma , 2002, Cancer.

[11]  M S Pepe,et al.  Comparing disease screening tests when true disease status is ascertained only for screen positives. , 2001, Biostatistics.

[12]  H. Halford,et al.  Cerebral imaging in the asymptomatic preoperative bronchogenic carcinoma patient: is it worthwhile? , 1994, The Annals of thoracic surgery.

[13]  Y. Ichinose,et al.  Preoperative examination to detect distant metastasis is not advocated for asymptomatic patients with stages 1 and 2 non-small cell lung cancer. Preoperative examination for lung cancer. , 1989, Chest.

[14]  W. Kim,et al.  Clinical investigation of EGFR mutation detection by pyrosequencing in lung cancer patients. , 2013, Oncology letters.

[15]  Julio Sánchez de Cos,et al.  Non-small cell lung cancer and silent brain metastasis. Survival and prognostic factors. , 2009, Lung cancer.

[16]  J. Cooper.  Ajcc Cancer Staging Manual , 1997 .