Nasser F. Alamri MBBS, Presenter: Nothing to Disclose

Hadas Moshonov PhD, Abstract Co-Author: Nothing to Disclose

Greg Korpanty MD, Abstract Co-Author: Nothing to Disclose

Natasha Leighl MD, Abstract Co-Author: Nothing to Disclose

Narinder S. Paul MD, Abstract Co-Author: Research funding, Toshiba Corporation

The purpose of this study is to investigate whether routine pelvic CT has a role in the baseline staging of lung cancer patients.

A retrospective review of an institutional lung cancer database containing 970 patients registered from 1/2002-1/2012. Inclusion criteria for the study required the following; a diagnosis of primary lung cancer established at our Institution, pelvic CT performed on initial staging CT and the availability of all images including subsequent MRI, CT-PET, Tc-99m bone scans and surveillance CT if performed. Histological confirmation of disease stage was also required. 225 patients satisfied the inclusion criteria. The primary study aims were to determine whether: a) the initial staging CT demonstrated evidence of pelvic metastases, b) if the presence of pelvic metastases changed the disease stage and / or c) if the presence of pelvic metastases changed patient management compared to review of the chest and abdominal images alone. Secondary study aims included the detection of occult pelvic metastases on MRI, bone scan or CT: PET and the detection of incidental abnormalities on the initial pelvic CT.

Of 225 lung cancer patients; 138 (61.6%) had disease limited to the thorax, 35 (15.6%) patients had abdominal and pelvis metastasis, and 5 (2.2%) patients had isolated pelvic metastasis. Of the 40 (17.8%) patients that had pelvic disease, 33 (82.5%) had metastases to the bony pelvis, and 5 (12.5%) had lymph node metastasis demonstrated on staging CT. Overall, the findings on pelvic CT did not change the disease stage in any patient. However, the findings on pelvic CT influenced patient management in 14/225 (6.2%) patients, compared to review of the chest and abdominal images alone, as these patients were referred for radiotherapy to treat the metastatic pelvic disease. Pelvic MRI or CT: PET images demonstrated occult pelvic metastases in an additional 2/225 (0.9%) of patients. Staging pelvic CT demonstrated incidental abnormalities in 15/225 (6.7%) patients.  

Pelvic CT performed routinely during baseline staging for lung carcinoma does not result in a change in disease stage but does influence patient management in 6% of patients.

Accurate baseline staging of lung cancer determines prognosis and patient management. Addition of routine pelvic CT to the staging protocol does not appear to provide additional prognostic information

Alamri, N, Moshonov, H, Korpanty, G, Leighl, N, Paul, N, The Utility of Routine Pelvic Imaging during CT Staging of Primary Lung Cancer.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13024940.html