NDLI: Does clinical T1N0 GGN really require checking for distant metastasis during initial staging for lung cancer?

Content Provider	Springer Nature : BioMed Central
Author	Imai, Kazuhiro Kurihara, Nobuyasu Konno, Motoko Mori, Naoko Takashima, Shinogu Kuriyama, Shoji Demura, Ryo Suzuki, Haruka Harata, Yuzu Fujibayashi, Tatsuki Shibano, Sumire Wakita, Akiyuki Nagaki, Yushi Sato, Yusuke Nomura, Kyoko Minamiya, Yoshihiro
Abstract	Background Accurate clinical staging is crucial for selection of optimal oncological treatment strategies in non-small cell lung cancer (NSCLC). Although brain MRI, bone scintigraphy and whole-body PET/CT play important roles in detecting distant metastases, there is a lack of evidence regarding the indication for metastatic staging in early NSCLCs, especially ground-grass nodules (GGNs). Our aim was to determine whether checking for distant metastasis is required in cases of clinical T1N0 GGN. Methods This was a retrospective study of initial staging using imaging tests in patients who had undergone complete surgical R0 resection for clinical T1N0 Stage IA NSCLC. Results A total of 273 patients with cT1N0 GGNs (n = 183) or cT1N0 solid tumors (STs, n = 90) were deemed eligible. No cases of distant metastasis were detected on initial routine imaging evaluations. Among all cT1N0M0 cases, there were 191 incidental findings on various modalities (128 in the GGN). Most frequently detected on brain MRI was cerebral leukoaraiosis, which was found in 98/273 (35.9%) patients, while cerebral infarction was detected in 12/273 (4.4%) patients. Treatable neoplasms, including brain meningioma and thyroid, gastric, renal and colon cancers were also detected on PET/CT (and/or MRI). Among those, 19 patients were diagnosed with a treatable disease, including other-site cancers curable with surgery. Conclusions Extensive staging (MRI, scintigraphy, PET/CT etc.) for distant metastasis is not required for patients diagnosed with clinical T1N0 GGNs, though various imaging modalities revealed the presence of adventitious diseases with the potential to increase surgical risks, lead to separate management, and worsen patient outcomes, especially in elderly patients. If clinically feasible, it could be considered to complement staging with whole-body procedures including PET/CT.
Related Links	https://cancerimagingjournal.biomedcentral.com/counter/pdf/10.1186/s40644-024-00714-7.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	14707330
DOI	10.1186/s40644-024-00714-7
Journal	Cancer Imaging
Issue Number	1
Volume Number	24
Language	English
Publisher	BioMed Central
Publisher Date	2024-06-03
Access Restriction	Open
Subject Keyword	Oncology Cancer Research Imaging Radiology Nuclear Medicine Lung neoplasms Diagnostic screening programs Neoplasm staging Incidental findings
Content Type	Text
Resource Type	Article
Subject	Radiological and Ultrasound Technology Radiology, Nuclear Medicine and Imaging Oncology
Journal Impact Factor	3.5/2023
5-Year Journal Impact Factor	4.3/2023

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