Does clinical T1N0 GGN really require checking for distant metastasis during initial staging for lung cancer?

Sep 21, 2026

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Accurate clinical staging guides optimal treatment selection in nonsmall cell lung cancer, yet evidence is limited for early-stage cT1N0 disease, particularly for ground-glass nodules (GGNs). This retrospective study assessed initial metastatic staging imaging in patients after complete surgical R0 resection for clinical T1N0 stage IA NSCLC. Among 273 eligible patients, no distant metastases were detected on routine evaluations, though incidental findings were common and included potentially treatable adventitious diseases. Conclusions support omitting extensive distant metastasis workup for clinical T1N0 GGNs when feasible.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Main Text Background

Clinical staging importance

Imaging modalities and controversy

Incidental findings and rationale for the study

Imai et al. Cancer Imaging (2024) 24:69 [https://doi.org/10.1186/s40644-024-00714-7](https://doi.org/10.1186/s40644-024-00714-7) Cancer Imaging RESEARCH ARTICLE Open Access Does clinical T1N0 GGN really require checking for distant metastasis during initial staging for lung cancer? Kazuhiro Imai 1*, Nobuyasu Kurihara 1, Motoko Konno2, Naoko Mori2, ShinoguTakashima 1, Shoji Kuriyama 1, Ryo Demura 1, Haruka Suzuki 1, Yuzu Harata 1, Tatsuki Fujibayashi 1, Sumire Shibano 1, Akiyuki Wakita 1, Yushi Nagaki 1, Yusuke Sato 1, Kyoko Nomura3 and Yoshihiro Minamiya 1 Abstract Background Accurate clinical staging is crucial for selection of optimal oncological treatment strategies in nonsmall cell lung cancer (NSCLC) . Although brain MRI, bone scintigraphy and whole-body PET/CT play important roles in detecting distant metastases, there is a lack of evidence regarding the indication for metastatic staging in early NSCLCs, especially ground-grass nodules (GGNs) . Our aim was to determine whether checking for distant metastasis is required in cases of clinical T1N0 GGN. Methods This was a retrospective study of initial staging using imaging tests in patients who had undergone complete surgical R0 resection for clinical T1N0 Stage IA NSCLC. Results A total of 273 patients with cT1N0 GGNs (n = 183) or cT1N0 solid tumors (STs, n = 90) were deemed eligible. No cases of distant metastasis were detected on initial routine imaging evaluations. Among all cT1N0M0 cases, there were 191 incidental findings on various modalities (128 in the GGN) . Most frequently detected on brain MRI was cerebral leukoaraiosis, which was found in 98/273 (35 . 9%) patients, while cerebral infarction was detected in 12/273 (4 .4%) patients. Treatable neoplasms, including brain meningioma and thyroid, gastric, renal and colon cancers were also detected on PET/CT (and/or MRI) . Among those, 19 patients were diagnosed with a treatable disease, including other-site cancers curable with surgery. Conclusions Extensive staging (MRI, scintigraphy, PET/CT etc.) for distant metastasis is not required for patients diagnosed with clinical T1N0 GGNs, though various imaging modalities revealed the presence of adventitious diseases with the potential to increase surgical risks, lead to separate management, and worsen patient outcomes, especially in elderly patients. If clinically feasible, it could be considered to complement staging with whole-body procedures including PET/CT. Keywords Lung neoplasms, Diagnostic screening programs, Neoplasm staging, Incidental findings *Correspondence: Kazuhiro Imai [i-karo@mui.biglobe. ne.jp](i-karo@mui.biglobe. ne.jp) 1Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan 2Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan 3Department of Health Environmental Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ([http://creativecommons.org/publicdomain/zero/

FAQs

What question does the study address for clinical T1N0 GGNs?

Whether checking for distant metastasis during initial staging is required in patients with clinical T1N0 GGNs.

How was the study conducted and who were the participants?

It was a retrospective study of initial staging imaging tests in patients who underwent complete surgical R0 resection for clinical T1N0 stage IA NSCLC.

What did the results show regarding distant metastasis on routine imaging?

No cases of distant metastasis were detected on initial routine imaging evaluations across the eligible patients.

What incidental findings were commonly detected and how might they affect management?

Imaging modalities revealed incidental findings, including brain abnormalities on brain MRI and other treatable neoplasms on PET/CT and/or MRI, which could increase surgical risks and lead to additional management.

Sep 21, 2026

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