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Brief Summary

GUIDELINE TITLE

Cross-sectional diagnostic imaging in lung cancer.

BIBLIOGRAPHIC SOURCE(S)

  • Cancer Care Ontario (CCO). Cross-sectional diagnostic imaging in lung cancer. Toronto (ON): Cancer Care Ontario (CCO); 2006 Apr 18. 25 p. [30 references]

GUIDELINE STATUS

This is the current release of the guideline.

Please visit the Cancer Care Ontario Web site for details on any new evidence that has emerged and implications to the guidelines.

BRIEF SUMMARY CONTENT

 RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

These recommendations were developed by radiology and oncology experts in Ontario and are informed by research evidence and clinical expertise.

Lung Cancer
Clinical/Diagnostic Problem Investigation* Recommendation Comment
Staging (with the exception of cerebral metastases) Computed tomography (CT) Indicated (primary)
  • Chest and upper abdomen imaging for all patients prior to the institution of a definitive treatment plan
  • In asymptomatic patients with stage I or II non-small cell lung cancer (NSCLC), the utility of extensive screening for metastatic disease is unproven; however, in practical terms, addition of upper abdominal CT to the initial CT thorax in investigation of possible lung masses probably represents optimal utilization of resources.
Magnetic resonance imaging (MRI) Indicated (supplementary)
  • Chest and upper abdomen imaging for specific patients as indicated in the American College of Chest Physicians (ACCP) guidelines (i.e., for evaluation of the brachial plexus or vertebral column in patients with NSCLC involving the superior sulcus) and when cardiac or mediastinal involvement is suspected.
  • Not indicated as the primary screening tool for the detection of other chest or abdominal metastases.
  • Abdominal MRI may be useful for clarification of potential metastases to liver or abdomen identified by CT.
Detection of cerebral metastases Cranial MRI Indicated (limited, primary)
  • Unless contraindicated (e.g., patient has a pacemaker), strongly recommended in symptomatic patients or asymptomatic patients with advanced NSCLC, small cell lung cancer (SCLC), and superior sulcus tumours for whom aggressive treatment may be appropriate.
  • Benefit for neurologically asymptomatic patients with early-stage NSCLC is unclear.
Cranial CT Indicated (limited, secondary) Use when MRI is contraindicated.
Assessment of tumour response CT Indicated (primary) In the absence of evidence, interval imaging with chest CT is reasonable with intervals likely based on the treatment schedule but at a frequency of no more than every 3 months.
MRI Indicated (supplementary) Cranial MRI may be considered in follow-up of cranial metastases.
Follow-up and Recurrence CT Indicated (limited)
  • Utility is dubious for post-treatment staging or routine screening of asymptomatic patients.
  • Conduct of imaging tests should be guided by:
    • The potential for recurrence according to the initial disease stage and treatment
    • The implications of a positive test for subsequent treatment (including palliation).
  • The use of a single imaging test should be considered unless multiple modalities will contribute to the treatment plan.
MRI Indicated (limited)

* CT scans may be used with or without intravenous contrast

CLINICAL ALGORITHM(S)

None provided

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EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The recommendations are supported by evidence-based guidelines, one report evaluating quality indicators, randomized trials, comparative cohort studies, pooled analyses of case series reports, and case series reports.

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IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • Cancer Care Ontario (CCO). Cross-sectional diagnostic imaging in lung cancer. Toronto (ON): Cancer Care Ontario (CCO); 2006 Apr 18. 25 p. [30 references]

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2006 Apr 18

GUIDELINE DEVELOPER(S)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

GUIDELINE DEVELOPER COMMENT

The Program in Evidence-based Care (PEBC) is a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

SOURCE(S) OF FUNDING

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

GUIDELINE COMMITTEE

Not stated

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Not stated

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

GUIDELINE STATUS

This is the current release of the guideline.

Please visit the Cancer Care Ontario Web site for details on any new evidence that has emerged and implications to the guidelines.

GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the Cancer Care Ontario Web site.

AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

  • Browman GP, Levine MN, Mohide EA, Hayward RSA, Pritchard KI, Gafni A, et al. The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation. J Clin Oncol 1995;13(2):502-12.

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI on October 29, 2006. The information was verified by the guideline developer on November 24, 2006.

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please refer to the Copyright and Disclaimer Statements posted at the Program in Evidence-Based Care section of the Cancer Care Ontario Web site.

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DISCLAIMER

NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.
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