PDF(Pubmed)
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.
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.
摘要：
背景：准确的临床分期对于选择非小细胞肺癌（NSCLC）的最佳肿瘤治疗策略至关重要。虽然脑部MRI,骨闪烁显像和全身PET/CT在检测远处转移中起重要作用，缺乏关于早期NSCLC转移分期指征的证据，尤其是地面草结节（GGNs）。我们的目的是确定在临床T1N0GGN的情况下是否需要检查远处转移。
方法：这是一项回顾性研究，对临床T1N0期IA非小细胞肺癌接受完全手术R0切除的患者使用影像学检查进行初始分期。
结果：共有273例cT1N0GGNs（n=183）或cT1N0实体瘤（STs，n=90)被认为是合格的。在最初的常规影像学评估中未检测到远处转移病例。在所有cT1N0M0病例中，在各种模态上有191个偶然发现(在GGN中有128个).在脑部MRI上最常见的是脑白质疏松症，在98/273（35.9%）患者中发现，而12/273(4.4%)患者发现脑梗死。可治疗的肿瘤，包括脑膜瘤和甲状腺，胃,在PET/CT(和/或MRI)上也检测到肾癌和结肠癌.其中,19名患者被诊断出患有可治疗的疾病，包括手术治愈的其他部位癌症。
结论：广泛分期(MRI，闪烁显像,PET/CT等.)诊断为临床T1N0GGNs的患者不需要进行远处转移，尽管各种成像方式显示存在不定疾病，有可能增加手术风险，导致单独管理，恶化患者的预后，尤其是老年患者。如果临床可行,它可以被认为是补充包括PET/CT在内的全身手术的分期。
方法：这是一项回顾性研究，对临床T1N0期IA非小细胞肺癌接受完全手术R0切除的患者使用影像学检查进行初始分期。
结果：共有273例cT1N0GGNs（n=183）或cT1N0实体瘤（STs，n=90)被认为是合格的。在最初的常规影像学评估中未检测到远处转移病例。在所有cT1N0M0病例中，在各种模态上有191个偶然发现(在GGN中有128个).在脑部MRI上最常见的是脑白质疏松症，在98/273（35.9%）患者中发现，而12/273(4.4%)患者发现脑梗死。可治疗的肿瘤，包括脑膜瘤和甲状腺，胃,在PET/CT(和/或MRI)上也检测到肾癌和结肠癌.其中,19名患者被诊断出患有可治疗的疾病，包括手术治愈的其他部位癌症。
结论：广泛分期(MRI，闪烁显像,PET/CT等.)诊断为临床T1N0GGNs的患者不需要进行远处转移，尽管各种成像方式显示存在不定疾病，有可能增加手术风险，导致单独管理，恶化患者的预后，尤其是老年患者。如果临床可行,它可以被认为是补充包括PET/CT在内的全身手术的分期。
