Many Early Lung Cancer Patients Receive Unnecessary Brain Scans

Brain CT and MRI for early stage lung cancer patients are not routinely recommended.

Many patients newly diagnosed with early non-small cell lung cancer (NSCLC) are undergoing brain imaging despite Choosing Wisely recommendations to the contrary, according to a study published in Chest.

Researchers sought to determine how brain imaging was used among asymptomatic patients with stage IA NSCLC, who were part of the National Lung Screening Trial.

The researchers identified 643 patients for the study. They had all received CT or MRIswithin 60 days after diagnosis, but before definitive surgical staging. The results showed that 77 (12%) of these patients had at least one brain imaging study, but of seven patients (1.1%) who were upstaged to stage IV, only two underwent brain imaging and neither had documentation of brain metastasis.

According to the findings, brain imaging frequency varied from 0% to 80%, depending on the enrollment center. “All patients who underwent brain imaging subsequently underwent surgery with curative intent, suggesting strongly that imaging revealed no evidence of intracranial metastases,” the authors wrote. Primary tumor size of less than 20 mm and being aged 65 to 69 were independently associated with greater use of brain imaging.[[{"type":"media","view_mode":"media_crop","fid":"48178","attributes":{"alt":"brain imaging","class":"media-image media-image-right","id":"media_crop_3770433627797","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5737","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 113px; width: 169px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Andrey Burmakin/","typeof":"foaf:Image"}}]]

The researchers concluded that one in eight patients enrolled in the National Lung Screening Trial underwent brain imaging, but no patient was found to have intracranial metastases. “Wide variation in use between centers suggests either lack of awareness or disagreement about this Choosing Wisely recommendation,” they wrote.