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. 2024 Jun 3;24(1):69.
doi: 10.1186/s40644-024-00714-7.

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

Kazuhiro Imai  1 , Nobuyasu Kurihara  2 , Motoko Konno  3 , Naoko Mori  3 , Shinogu Takashima  2 , Shoji Kuriyama  2 , Ryo Demura  2 , Haruka Suzuki  2 , Yuzu Harata  2 , Tatsuki Fujibayashi  2 , Sumire Shibano  2 , Akiyuki Wakita  2 , Yushi Nagaki  2 , Yusuke Sato  2 , Kyoko Nomura  4 , Yoshihiro Minamiya  2
Affiliations

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

Kazuhiro Imai et al. Cancer Imaging. .

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.

Keywords: Diagnostic screening programs; Incidental findings; Lung neoplasms; Neoplasm staging.

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Conflict of interest statement

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Flow chart illustrating the subject enrollment protocol
Fig. 2
Fig. 2
Kaplan-Meier curves comparing 5-year overall survival, relapse-free survival, and disease-free survival between patients with cT1N0 ground-grass nodules (GGNs) and solid tumors (STs). Only overall survival differed between the GGN and ST groups (p = 0.0382)
Fig. 3
Fig. 3
Incidental findings of treatable malignant potential tumor during preoperative imaging (A) Case 4 (71-year-old male with bilateral GGNs in right S1 and left S1 + 2): Gallbladder cancer was detected on contrast-enhanced (CE)-CT. CT revealed 18 mm pedunculated tumor without invasion into the liver parenchyma. Case 4 received extended cholecystectomy before pulmonary resection. (B) Case 7 (86-year-old female with right S6 GGN): Renal cancer was detected on CE-CT and PET/CT. The 10 mm nodule showed hyperenhancement in the arterial phase and washout in the equilibrium phase of CE-CT. Case 7 was followed up with CT after pulmonary resection. (C) Case 8 (75-year-old male with right S7 GGN): Gastric cancer was detected on PET/CT. PET/CT showed anterior gastric wall thickening and high maximum standardized uptake value (SUVmax 27.9) in the pyloric end of stomach. After pulmonary resection, Case 8 received distal gastrectomy with D2 lymph node dissection and the final pathological stage was IIIB. (D) Case 9 (77-year-old female with left S1 + 2 GGN and left breast cancer 5.5 cm, pT1cN0): Meningioma was detected on brain MRI. The enhancing brain mass adjacent to the anterior cranial base was 20 mm, with edematous. Case 9 was followed up with CT after pulmonary resection. Case 9 had no tumor-related symptoms. (E) Case 17 (56-year-old female with right S1 solid adenocarcinoma): Thyroid papillary carcinoma was detected on PET/CT. The low-density nodule showed SUVmax 7.0. Case 17 received thyroidectomy after pulmonary resection (F) Case 18 (68-year-old male with right S1 solid adenocarcinoma): Sigmoid colon cancer was detected on CE-CT and PET/CT (conducted at another hospital). PET/CT revealed sigmoid colonic wall thickening and high FDG uptake. Case 18 received laparoscopic sigmoidectomy with D2 lymph node dissection before pulmonary surgery
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References

    1. Chang B, Hwang JH, Choi YH, et al. Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest. 2013;143:172–8. doi: 10.1378/chest.11-2501. - DOI - PubMed
    1. Cho H, Lee HY, Kim J, et al. Pure ground glass nodular adenocarcinomas: are preoperative positron emission tomography/computed tomography and brain magnetic resonance imaging useful or necessary? J Thorac Cardiovasc Surg. 2015;150:514–20. doi: 10.1016/j.jtcvs.2015.06.024. - DOI - PubMed
    1. Postmus PE, Kerr KM, Oudkerk M, ESMO Guidelines Committee et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(suppl4):iv1–21. doi: 10.1093/annonc/mdx222. - DOI - PubMed
    1. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: non-small cell lung cancer [Internet]. Fort Washington: National Comprehensive Cancer Network. 2023. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed March 10, 2023.
    1. Bustos García de Castro A, Ferreirós Domínguez J, Delgado Bolton R, et al. PET-CT in presurgical lymph node staging in non-small cell lung cancer: the importance of false-negative and false-positive findings. Radiologia. 2017;59:147–58. doi: 10.1016/j.rx.2016.12.001. - DOI - PubMed

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