title: Brain metastases following radical surgical treatment of non-small cell lung cancer: is preoperative brain imaging important?
abstract: OBJECTIVE
  There is a lack of good quality evidence or a clear consensus of opinion internationally regarding who should receive preoperative imaging of the brain prior to radical treatment for non-small cell lung cancer (NSCLC). We aimed to establish the proportion of patients who developed brain metastases following curative surgery and to estimate how many could have been detected by preoperative magnetic resonance imaging (MR).
  
  
  METHODS
  We performed a retrospective analysis of 646 patients who underwent surgery for lung cancer with curative intent at a regional thoracic surgical centre in the United Kingdom. We identified those who developed brain metastases in the postoperative period and, by using volume doubling times, estimated the size of the metastasis at the time of surgery. We then determined the proportion of metastases that would have been seen on preoperative MR brain at detection thresholds of 2 and 5mm diameter.
  
  
  RESULTS
  There was a 6.3% incidence of postoperative brain metastases, with the majority occurring within 12 months of surgery. Those who developed metastases were more likely to have adenocarcinoma and the majority had early stage malignancy (73% stage I or stage II). We estimate that 71% of those who developed cerebral metastases might have been detected had they undergone MR brain as part of their staging (4.4% of all patients).
  
  
  CONCLUSIONS
  Based on our findings we suggest that, in addition to standard staging investigations, patients have brain imaging (MR or equivalent) prior to curative surgery in NSCLC regardless of preoperative stage.
authors.affiliation: Division of Public Health and Epidemiology, Clinical Sciences Building, Nottingham City Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom. Electronic address: emma.o'dowd@nottingham.ac.uk.
authors.forename: Emma L
authors.initials: EL
authors.lastname: O'Dowd
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: Maruti
authors.initials: M
authors.lastname: Kumaran
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: Sadia
authors.initials: S
authors.lastname: Anwar
authors.affiliation: Department of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Palomo
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: David R
authors.initials: DR
authors.lastname: Baldwin
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D059906:Neuroimaging; D011300:Preoperative Care; D047368:Tumor Burden
keywords: Brain metastases; Lung cancer; MR brain; PET-CT; Pre-operative; Staging