Original Articles: General ThoracicExtrathoracic staging is not necessary for non-small-cell lung cancer with clinical stage T1–2 N0
Section snippets
Patients and methods
We analyzed records of all patients with a histologic diagnosis of lung cancer, referred to the National Cancer Center Hospital East and the National Matsudo Hospital (former institute of the National Cancer Center Hospital East) between January 1982 and May 1996. The staging protocol during this period consisted of enhanced chest CT, radioisotope bone scanning, enhanced MRI or CT of the brain, and abdominal enhanced CT or ultrasonography.
Eight hundred three patients had NSCLC in clinical stage
Results
Of the 419 clinical T1 N0 cases, nine (2.1%) extrathoracic metastases were detected by radiographic staging procedures (Table 2). Seven of nine had clinical findings of distant metastasis. Of the 335 clinical T2 N0 cases, 20 distant metastatic sites in 18 patients (5.4%) were detected. Fifteen of the 18 patients had the clinical findings. All these metastases detected by the imaging procedures were confirmed as true positive by following their clinical courses.
The metastatic sites and the
Comment
This large volume retrospective study determined the frequency of detection of extrathoracic metastasis in NSCLC patients with clinical stage T1–2 N0, and the incidence of clinical and laboratory abnormalities suggestive of distant metastasis in this population.
Our results showed that even if a tumor does not seem to invade any lymph nodes on chest CT, distant metastasis can be detected by full staging procedures. However, the imaging procedures could provide accurate staging in only a few
Acknowledgements
This study was supported in part by a Grant-in-Aid for Cancer Research (8S-1, 9-18, 9-29) from the Japanese Ministry of Health and Welfare.
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2021, Clinical Lung CancerCitation Excerpt :Alternatively, European Society for Medical Oncology (ESMO) notes that screening for brain metastases by magnetic resonance imaging (MRI) might be useful in patients considered for curative therapy.1 A previous study demonstrated a low incidence (<3%) of occult brain metastasis in patients with stage I NSCLC, assessed with the staging protocol (enhanced chest CT, radioisotope bone scanning, enhanced MRI or CT of the brain, and abdominal enhanced CT or ultrasonography).5 In 2016, a secondary analysis of a prospective study from the National Lung Screening Trial showed that very few patients (1%) initially classified with clinical IA NSCLC, had eventually stage IV disease, none of which involved the brain; however, only 12% of the study population had brain imaging and the unified staging procedure was not followed.7
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2019, Clinical Lung CancerCitation Excerpt :In the 1980s and 1990s, the utility and cost-effectiveness of brain MRI for patients with lung cancer was analyzed. Tanaka et al evaluated 755 patients with clinical T1-2N0 NSCLC fully staged with contrast enhanced computed tomography (CT) chest/abdomen imaging, bone scan, and contrast-enhanced MRI or CT of the brain and found rates of asymptomatic extrathoracic metastases of < 1% for T1 and T2 patients, deeming MRI unnecessary in this subset of patients owing to cost and delay of care.12 Another Japanese study of 332 patients with potentially operable NSCLC staged with CT or MRI found new brain metastases in 3.4% of the MRI group and 0.6% of the CT group.13