Neurological examination and brain computed tomography in the initial staging of non-small-cell lung cancer (NSCLC): a prospective study.

Brain metastases occur in 17 to 40% of lung carcinoma and 30 to 60% of brai n metastases originate from a lung carcinoma. Brain metastasis directly inf luences prognosis and treatment of lung cancer. The aim of this study was t o prospectively compare the findings of the neurological examination perfor med by a neurologist and results of double dose delayed computed tomography (CT DDD). The neurologist and radiologist were blinded to each other's res ults. Patients included had non-small-cell lung cancer (NSCLC) and were neu rologically asymptomatic with no other cancer. From November 1993 to May 1996, 135 patients were included (126 men and 9 w omen). Ninety neurological examinations were normal, 34 suggested brain met astasis and II were abnormal but did not suggest brain metastasis. One hund red thirteen CTs were normal, I showed a brain metastasis and II were abnor mal but did not evidence brain metastasis. The sensitivity, specificity, po sitive predictive value and negative predictive value of the neurological e xamination were 73, 79, 23 and 97% respectively. The presence of brain meta stasis was directly related to tumor stage but not to age or histology. We suggest that brain CT DDD should be performed in stage IIIA, IIIB, IV wh ereas in stage I or II, the neurological examination is sufficient. However , a larger number of patients would be required to confirm these findings.