Neuroimaging in Staging patients with lung Cancer
It is important to detect brain metastases in patients with newly diagnosed advanced lung cancer intended for curative treatment. To this end, NICE suggests considering MRI or CT head especially in stage III disease and SIGN 2014 recommends contrast CT head or MRI in N2 disease. It is also important to use resources appropriately. SIGN also recommends that patients with stage I-II do not require such imaging unless clinically indicated.(1-4)
1. All patients with N2 or stage III lung cancer being considered for curative intent should have brain imaging.
2. Patients with stage I-II lung cancer should not have unnecessary brain imaging.
Percentage of patients identified through lung cancer MDT having appropriate neuroimaging for staging purposes.
Target: Aim 100% compliance.
Method (1st and 2nd Audit rounds):
Data collection :
1st round: February 2015 – September 2016 2nd Round: October 2016 - July 2017
Patients’ clinical data collected from a prospectively maintained MDT cancer web based system. Patients’ imaging information collected retrospectively from RIS system and PACS for both Ayr and Crosshouse hospitals.
Part 1 – stage III or N2 disease (can co-exist)
Part 2 – stage I-II disease
Exclusion criteria: small cell cancer; mesothelioma; patients not intended for curative treatment
Results (1st Audit round )
Total 529 patients 134 met criteria (both part 1 and part 2 patients)
Part 1: 43 were stage III and/or N2 10/43 (23%) had Neuroimaging (1/10 had positive results for brain metastasis)
Part 2: 91 were stage I - II disease 15/91 (16%) had Neuroimaging
1st Action Plan
Results (2nd Audit round )
Total 174 patients 45 patients for curative intent 12 patients stage III and/or N2 4/12(33%) had neuroimaging
(both part 1 and 2) (part 1 only patients)
1/ 4 (25%) had positive result for brain metastasis.
2nd Action Plan
Patients with Stage III and/or N2 lung cancer planned for curative treatment represent a small group (55 patients over a 30 month period) with significant percentage in detecting brain metastases (10% 1st round and 25% 2nd round) when partially imaging this group. In this local audit, 23% (first round) and 33% (second round) had brain imaging but due to neurological symptoms rather than compliance with guidelines. However, in accordance with guidelines, no stage I-II patients were inappropriately imaged. By adhering to NICE/SIGN 2014 guidelines there is only a minimal increase in the local radiology department workload (approximately 2 additional brain scans/month).