Guideline adherence in action: Baseline neuroimaging rates for NSCLC—A Northern Ireland North West Cancer Centre single-institution experience.

Abstract

e20653 Background: Brain metastases are common in patients with Non-Small Cell Cancer (NSCLC) and significantly impact treatment selection and outcomes. Clinical guidelines recommend baseline neuroimaging; however real-world adherence has historically been inconsistent. We evaluated changes in neuroimaging utilization among patients with NSCLC to assess improvement in staging practices. Methods: A retrospective review of patients with newly diagnosed NSCLC evaluated at North West Cancer Centre in 2020 and 2023. Baseline neuroimaging utilization was assessed, including computed tomography (CT) brain, magnetic resonance imaging (MRI) brain, or no brain imaging prior to treatment initiation. Imaging patterns were compared descriptively between cohorts. Results: A total of 60 and 50 patients were evaluated in 2020 and 2023 respectively. In 2020, 60% of patients (36 out of 60) had CT brain imaging. By 2023, this number rose to 41 out of 50 patients (82%). MRI utilisation increased slightly, from 3 patients (5%) in 2020 to 4 patients (8%) in 2023. The proportion of patients who did not receive any baseline brain imaging dropped from 21 out of 60 (35%) in 2020 to just 5 out of 50 (10%) in 2023. Baseline neuroimaging adherence improved from 65.0% in 2020 to 90.0% in 2023. The difference in proportions was 25.0% (95% CI: 39.7% to 10.3%). A two-proportion z-test demonstrated that this increase was statistically significant (z = -3.07, p = 0.0021), indicating a robust improvement in guideline adherence over time. The increased imaging rates led to earlier and more accurate detection of brain metastases, enabling timely multidisciplinary decision-making and optimised treatment planning. Conclusions: Over the three-year study period, a substantial improvement in the utilisation of baseline brain imaging for patients newly diagnosed NSCLC has been witnessed. Adherence to guideline-recommended neuroimaging increased markedly from 65% to 90%. This upward trend was accompanied by a significant reduction in the proportion of patients who remained un-staged at diagnosis, underscoring the effectiveness of targeted institutional efforts. Notably, the enhanced imaging rates translated into earlier and more accurate detection of brain metastases, facilitating timely multidisciplinary decision-making and optimised treatment planning. These results reflect a successful alignment of clinical practice with national guidelines and demonstrate the tangible impact of focused quality improvement initiatives within a single regional cancer centre.