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Despite recommendations, some patients with early-stage, asymptomatic NSCLC undergo brain imaging
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The incidence of brain imaging among patients with early-stage non–small cell lung cancer enrolled in the National Lung Screening Trial varied despite recommendations against imaging in this population, according to study results.
Brain imaging occurred more frequently in older patients and patients with larger tumors, according to the researchers.
“Recently, the American Board of Internal Medicine Foundation launched the Choosing Wisely campaign to discourage the excessive use of low-value interventions; one such recommendation from the Society of Thoracic Surgeons was to avoid ordering brain imaging in early-stage NSCLC patients who do not report neurologic symptoms,” Alex A. Balekian, MD, MSHS, assistant professor of clinical medicine at University of Southern California’s Keck School of Medicine, and colleagues wrote. “Prior studies of patients with pathological stage I NSCLC have shown that asymptomatic brain metastases occur rarely.”
Balekian and colleagues sought to observe the extent of brain imaging used among National Lung Screening Trial participants with stage IA NSCLC. Further, they aimed to identify factors associated with the receipt of brain imaging.
The researchers identified patients with clinical stage IA disease who received CT or MRI within 60 days of diagnosis but prior to definitive surgical staging. They used multivariate logistic regression to identify variables associated with continual brain imaging.
The study included data from 643 patients (median age, 64 years; 54% men). Twelve percent of patients (n = 77) underwent at least one brain imaging study.
The frequency of brain imagining receipt varied from 0% to 80% based on enrollment center.
All patients who underwent brain imagining — including two patients who were later upstaged to stage IV disease — underwent surgery with curative intent, which suggested that imagining produced no evidence of intracranial metastases, according to the researchers.
In a multivariate analysis, brain imagining appeared more likely among patients with larger (> 20 mm) primary tumors (OR = 2.5; 95% CI, 1.5-4.16), as well as those aged 65 to 69 years (OR = 2.78; 95% CI, 1.38-5.57).
The researchers acknowledged limitations of their study, including their exclusion of patients with tumors greater than 30 mm in size or with clinical M1 disease. Further, they acknowledged that they could not ascertain whether patients truly lacked neurological symptoms.
“The Choosing Wisely recommendation for avoiding brain imaging in asymptomatic stage IA NSCLC patients is supported by this study and efforts should be made to monitor and improve adherence,” Balekian and colleagues wrote. – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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