Diaz Mauricio E, Debowski Maciej, Hukins Craig, Fielding David, Fong Kwun M, Bettington Catherine S
Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Department of Thoracic Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
J Med Imaging Radiat Oncol. 2018 Jun;62(3):383-388. doi: 10.1111/1754-9485.12732. Epub 2018 May 10.
Several clinical guidelines indicate that brain metastasis screening (BMS) should be guided by disease stage in non-small cell lung cancer (NSCLC). We estimate that screening is performed more broadly in practice, and patients undergo brain imaging at considerable cost with questionable benefit. Our aim was to quantify the use and detection rate of BMS in a contemporary cohort staged with F-fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT).
We conducted a retrospective review of prospectively collected data from three major lung cancer referral centres in Brisbane between January 2011 and December 2015. Patients included had a new diagnosis of NSCLC and had undergone a PET-CT to stage extra-cranial disease. BMS was defined as dedicated brain imaging with contrast-enhanced computed tomography (CE-CT) or magnetic resonance (MR), in the absence of clinically apparent neurological deficits.
A total of 1751 eligible cases were identified and of these 718 (41%) underwent BMS. The majority had CE-CT imaging (n = 703). Asymptomatic brain metastases (BM) were detected in 18 patients (2.5%). Of these patients, 12 had concurrent non-brain metastases. Only six patients (0.8%) had BM alone. The rate of detection increased with N-stage (P = 0.02) and overall stage (P < 0.001). It was 0.5%, 1%, 1.6% and 7.3% for stage I, II, III and IV respectively. The overall screening rate increased with T-stage (P = 0.001), N-Stage (P < 0.001) and overall stage (P < 0.001).
Non-small cell lung cancer BMS practices remain at odds with published guidelines. The low number of occult BMs detected supports the existing international recommendations. Rationalising BMS would minimise the burden on patients and the health care system.
多项临床指南指出，非小细胞肺癌（NSCLC）的脑转移筛查（BMS）应以疾病分期为指导。我们估计，在实际操作中筛查的范围更广，患者接受脑部成像检查的费用高昂，但获益存疑。我们的目的是量化在采用F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET-CT）进行分期的当代队列中BMS的使用情况和检出率。
我们对2011年1月至2015年12月期间从布里斯班的三个主要肺癌转诊中心前瞻性收集的数据进行了回顾性分析。纳入的患者为新诊断为NSCLC且已接受PET-CT以对颅外疾病进行分期的患者。BMS定义为在无明显临床神经功能缺损的情况下，使用对比增强计算机断层扫描（CE-CT）或磁共振成像（MR）进行专门的脑部成像检查。
共确定了1751例符合条件的病例，其中718例（41%）接受了BMS。大多数患者接受了CE-CT成像检查（n = 703）。在18例患者（2.5%）中检测到无症状脑转移（BM）。在这些患者中，12例同时患有非脑转移。只有6例患者（0.8%）单独患有BM。检出率随N分期（P = 0.02）和总分期（P < 0.001）的增加而升高。I期、II期、III期和IV期的检出率分别为0.5%、1%、1.6%和7.3%。总体筛查率随T分期（P = 0.001）、N分期（P < 0.001）和总分期（P < 0.001）的增加而升高。
非小细胞肺癌BMS的实际操作与已发表的指南仍不一致。检测到的隐匿性BM数量较少支持了现有的国际建议。合理安排BMS将使患者和医疗保健系统的负担最小化。
