88P - Use of brain imaging in the management of patients with lymph node negative multifocal lung cancer

Date 15 April 2016
Event European Lung Cancer Conference 2016 (ELCC) 2016
Session Poster lunch
Topics Staging procedures (clinical staging)
Thoracic malignancies
Basic Principles in the Management and Treatment (of cancer)
Presenter Konstantinos Leventakos
Citation Journal of Thoracic Oncology (2016) 11 (supplement 4): S57-S166. S1556-0864(16)X0004-4
Authors K. Leventakos1, A.S. Mansfield1, S. Blackmon2, S. Cassivi2, R. Shen2, F.C. Nichols2, J.R. Molina1, M.S. Allen2, M.C. Aubry3, D. Wigle2
  • 1Department Of Medical Oncology, Mayo Clinic, 55905 - Rochester/US
  • 2Department Of Thoracic Surgery, Mayo Clinic, 55905 - Rochester/US
  • 3Department Of Laboratory Medicine And Pathology, Mayo Clinic, 55905 - Rochester/US



Multifocal lung cancer is a challenging clinical scenario in which patients may have separate primary lung cancers or metastatic disease from a primary lesion. Herein, we report our experience with brain imaging to rule out extrapulmonary metastatic disease in patients being considered for surgical intervention for multifocal lung cancer.


At Mayo Clinic we have instituted a systematic approach for the treatment of multifocal lung cancer (NCT01946100). We reviewed the records of patients who presented for management of suspected multifocal lung cancer, had brain imaging at the time of their initial oncologic assessment and had no radiographic evidence of lymph node involvement.


We identified 146 patients who were evaluated between January 2000 and December 2014 for suspected multifocal lung cancer without radiographic lymph node involvement and 32 of them had brain imaging obtained at the time of their initial diagnosis (Table 1). In 25 patients (78%) the lesions were synchronous. MRI was used in 28 patients (88%) and CT was used in 4 patients (12%). Results were inconclusive for two of these patients (6%) and additional brain imaging was performed. MRI was consistent with metastatic disease to the brain in two patients (6%) that had otherwise no neurologic symptoms. Both of these patients were female, older than 75 years, previous smokers with 2 synchronous lesions in their lungs at diagnosis. One had squamous cell carcinoma and one had poorly differentiated carcinoma. In both of these patients surgical approaches were deferred.


In our series, brain imaging successfully identified metastatic disease in two of 32 patients (6%) and drastically changed their management. Brain imaging may be a valuable tool in the personalization of care for this heterogeneous population.

Clinical trial identification

Legal entity responsible for the study

Mayo Clinic


Mayo Clinic


All authors have declared no conflicts of interest. 88PT1 Table 1: Clinical, radiologic and histologic data of 32 patients presenting with node negative multifocal lung cancer

Age (years)69 (48–84)
 Female19/32 (59%)
 Male13/32 (41%)
Smoking Status 
 Current7/32 (22%)
 Previous21/32 (66%)
 Never smokers4/32 (12%)
 Pack-years54 (5–120)
Family History of Lung Cancer3/32 (9%)
 Caucasian32/32 (100%)
Lesions at diagnosis per patient2.4 (1–6)
 1 lesion at diagnosis2/32 (6%)
 2 lesions at diagnosis19/32 (59%)
 3 lesions at diagnosis9/32 (28%)
 4 lesions at diagnosis1/32 (3%)
 6 lesions at diagnosis1/32 (3%)
Lobes involved in diagnosis 
 1 lobe involved7/32 (22%)
 2 lobes involved15/32 (78%)
Unilateral disease7/32 (22%) Right lung: 4 cases; Left lung: 3 cases
Bilateral disease25/32 (78%)
Size of lesions (cm; n = 90)2.7 (0.7–8.6)
Size of the largest lesion 
 Less than 3 cm15/32 (47%)
 3–7 cm14/32 (44%)
 Larger than 7 cm3/32 (9%)
T staging of largest lesion (AJCC,7th edition) 
 T110/32 (31%)
 T27/32 (22%)
 T312/32 (38%) 10 cases with lesions in same lobe – 2 cases based on size
 T43/32 (9%) 1 case with lesion in different ipsilateral lobe; 2 cases with invasion of nearby structures
Biopsy results in the same patient 
 Adenocarcinoma only23/32 (71%)
 SQCC only2/32 (6%)
 Adenocarcinoma + SQCC2/32 (6%)
 Adenocarcinoma + MALT1/32 (3%)
 Adenocarcinoma + neuroendocrine tumor1/32 (3%)
 Adenocarcinoma + sarcomatoid tumor1/32 (3%)
 Adenocarcinoma + poorly differentiated carcinoma1/32 (3%)
 SQCC + poorly differentiated carcinoma1/32 (3%)