Brain imaging before primary lung cancer resection: a controversial topic

Area of Science:

• Oncology
• Radiology
• Thoracic Surgery

Background:

• National guidelines for brain imaging in non-small cell lung cancer (NSCLC) patients undergoing curative resection are inconsistently applied in the UK.
• Current recommendations lack high-quality evidence and do not consider cost or local resources.

Purpose of the Study:

• To evaluate local practice and historical outcomes for brain metastases in patients undergoing potentially curative lung cancer resection.
• To determine the incidence and timing of brain metastases in this patient cohort.

Main Methods:

• Retrospective analysis of pathology and radiology records from January 2012 to December 2014 at a UK regional thoracic surgical centre.
• Inclusion of 585 patients who underwent lung resection with curative intent; 471 had accessible radiology records.
• Data collected included histology, TNM stage, resection margins, and presence/timing of brain metastases.

Main Results:

• Brain metastases were identified in 5.3% (25/471) of patients with accessible records.
• Of these, 3.8% (18/471) presented with brain metastases after surgical resection, with a median detection time of 295 days post-resection.
• Adenocarcinoma and squamous cell carcinoma were the most common histological subtypes associated with brain metastases.

Conclusions:

• The rate of brain metastases is comparable to previous studies, suggesting preoperative staging may significantly alter management for some patients.
• Preoperative brain imaging can spare patients non-curative surgery or enable aggressive treatment of oligometastatic disease.
• Routine preoperative MRI brain imaging is recommended for all patients undergoing potentially curative lung resection.