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B. Gangadharan
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P1.13 - Radiology/Staging/Screening (ID 699)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.13-010 - Is MRI Brain Mandatory in All Patients with Early Stage NSCLC? (ID 9779)
09:30 - 09:30 | Author(s): B. Gangadharan
- Abstract
Background:
Non - small cell lung cancer(NSCLC) is known to have a high propensity for metastasis to brain. Conventional wisdom and guidelines recommend MRI brain as routine staging investigation for patients planned for radical treatment. However there is little data about the detection rate of brain metastasis using MRI brain in asymptomatic patients with operable/early stage NSCLC.
Method:
We conducted a prospective observational study to assess the incidence of MRI detected brain metastasis in early operable lung cancer. Consecutive patients presenting to the outpatient department with biopsy proven NSCLC were screened. All patients planned for radical treatment underwent PET CECT and MRI brain as per institutional protocol. Patients with early stage disease( Stage I to IIIA) on PET CECT with no symptoms suggestive of brain metastasis were included in the study. Data regarding histopathology, T stage, N stage, SUV uptake of primary, clinicoradiological stage, neurological symptoms and MRI brain findings was collected.
Result:
1944 consective biopsy proven patients of NSCLC presenting in the outpatient department from Jan 1st 2015 to Dec 31st 2015, were screened. 168 patients in stage I to IIIA as per PET CECT, without obvious evidence of brain metastastis were included in the study, 81(48.2%) were in stage I&II and 87(51.7%) were in stage IIIA. Among the remaining 1776 patients, 213 patients had brain metastasis at presentation. Two patients with early stage disease and symptomatic solitary brain metastasis were treated with radical intent and excluded from the study. The incidence of MRI detected asymptomatic brain metastasis in the study population(Stage I to IIIA) was 6/168 (3.5%) and all were in stage IIIA. MRI brain did not pick up any brain metastasis in asymptomatic Stage I&II NSCLC patients. No co-relation could be found between grade of tumour, SUV of primary, T stage or N stage with the incidence of brain metastasis. Three patients in the study population developed brain metastasis while on treatment.
Conclusion:
Although this study is limited by the small sample size, the role of MRI brain in staging of early stage NSCLC (Stage I & II) needs to be re evaluated in light of the low yield seen in asymptomatic patients. Rigorous evaluation of the patient's history and clinical symptoms may obviate the need of MRI brain in this subset. This may become increasingly relevant with the implementation of lung cancer screening programs.
