Mayer Nora, Boschetti Laura, Scarci Marco, Cioffi Ugo, De Simone Matilde, Schnider Marlène, Kestenholz Peter, Minervini Fabrizio
Division of Thoracic Surgery, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland.
Department of Medical Oncology, Cantonal Hospital Lucerne, 6210 Sursee, Switzerland.
J Clin Med. 2025 Jan 22;14(3):708. doi: 10.3390/jcm14030708.
: Lung cancer frequently metastasizes to the brain, liver, and adrenal glands with a significant negative prognostic impact on overall survival and quality of life (QoL). To optimize treatment and prognosis, adequate staging with the detection of distant metastases is crucial. The incidence of brain metastases in potentially resectable early-stage non-small cell lung cancer (NSCLC) is as low as 3%; hence, the need for preoperative brain imaging has been a constant matter of debate, especially in stage II. In stages III and IV NSCLC, neuroimaging is an essential part of staging. : A systematic literature search was performed. Publications from 1999 to 2024, focusing on preoperative brain imaging (BI) in the staging of stages I-IV NSCLC, were included. Data extraction included study population characteristics, the modality of BI, the incidence of brain metastases (BMs), and the main outcomes of the studies. The final included studies were selected according to the PRISMA criteria. In the second step, guidelines on BI in NSCLC staging of major importance were identified and compared. : A total of 530 articles were identified, of which 25 articles were selected. Four prospective studies and 21 retrospective investigations were included. Most of the investigations focused on BI in the early stages. The main imaging modality for BI was magnetic resonance imaging (MRI), followed by computed tomography (CT). Besides the identified 25 studies, the most important internationally applied guidelines on brain imaging in the staging of NSCLC were reviewed. While some guidelines agree on preoperative BI in NSCLC stage III (Union for International Cancer Control-UICC eighth edition) patients, other guidelines recommend earlier BI starting from clinical stage II. All mentioned guidelines homogenously recommend BI in patients with symptoms suggestive of brain pathologies. : BI in NSCLC staging is recommended in neurologically symptomatic patients suggestive of brain metastases as well as NSCLC patients with stage III disease. Neuroimaging in stage IA patients, as well as in pure GGO (Ground-Glass Opacity) lesions, was considered unnecessary. The predominantly applied imaging modality was ce-MRI (contrast-enhanced magnetic resonance imaging). Inconsistency exists concerning BI in stage II. The identification of prognostic factors for developing BM in patients with early-stage NSCLC could help to clarify which subgroup might benefit from preoperative BI.
肺癌常转移至脑、肝和肾上腺，对总生存期和生活质量（QoL）有显著的负面预后影响。为优化治疗和预后，通过检测远处转移进行充分分期至关重要。在潜在可切除的早期非小细胞肺癌（NSCLC）中，脑转移的发生率低至3%；因此，术前脑成像的必要性一直是争论的焦点，尤其是在II期。在III期和IV期NSCLC中，神经成像检查是分期的重要组成部分。
进行了系统的文献检索。纳入了1999年至2024年期间聚焦于I-IV期NSCLC分期中术前脑成像（BI）的出版物。数据提取包括研究人群特征、BI的方式、脑转移（BMs）的发生率以及研究的主要结果。最终纳入的研究根据PRISMA标准进行选择。第二步，确定并比较了NSCLC分期中关于BI的重要指南。
共识别出530篇文章，其中25篇被选中。包括4项前瞻性研究和21项回顾性调查。大多数研究聚焦于早期的BI。BI的主要成像方式是磁共振成像（MRI），其次是计算机断层扫描（CT）。除了已识别的25项研究外，还回顾了NSCLC分期中最重要的国际应用脑成像指南。虽然一些指南对于NSCLC III期（国际癌症控制联盟-UICC第八版）患者的术前BI意见一致，但其他指南建议从临床II期开始更早进行BI。所有提及的指南均一致推荐对有脑病变症状的患者进行BI。
对于有脑转移提示症状的神经症状患者以及III期疾病的NSCLC患者，建议在NSCLC分期中进行BI。对于IA期患者以及纯磨玻璃密度（GGO）病变患者，认为无需进行神经成像检查。主要应用的成像方式是增强磁共振成像（ce-MRI）。关于II期的BI存在不一致之处。识别早期NSCLC患者发生BM的预后因素有助于明确哪些亚组可能从术前BI中获益。
