Metastatic Workup for Pulmonary Squamous Cell Carcinoma

Essential Imaging Studies

The European Society for Medical Oncology recommends performing contrast-enhanced CT of the chest and upper abdomen, brain imaging (preferably MRI), and PET-CT for comprehensive metastatic assessment, with histological confirmation of solitary metastatic sites when feasible 1
PET-CT offers the highest sensitivity for detecting mediastinal lymph node involvement and distant metastases and should be performed for comprehensive staging 3, 4
Brain imaging should be considered at diagnosis for all patients with metastatic disease, with MRI being more sensitive than CT for detecting brain metastases 1, 3

The European Society for Medical Oncology recommends obtaining cytological or histological confirmation of stage IV disease when imaging reveals a solitary metastatic site, before finalizing treatment decisions 1, 3, 4

Document complete smoking history, weight loss, ECOG performance status, and comorbidities, and perform thorough physical examination focusing on signs of metastatic disease 1

Molecular testing is generally NOT recommended for squamous cell carcinoma unless the patient is a never-smoker or former light smoker (<15 pack-years) 3

Stage according to AJCC/UICC TNM 8th edition staging manual, and measurement of lesions should follow RECIST criteria version 1.1 1, 3, 4

For solitary brain metastasis, consider surgical resection followed by whole-brain radiotherapy or stereotactic radiosurgery 2
For solitary adrenal metastasis, resection of both adrenal and primary tumor may provide prolonged survival in selected patients 3

For patients with PS 0-1 and no contraindications to immunotherapy, platinum-based chemotherapy combined with pembrolizumab is the standard first-line treatment for metastatic squamous cell carcinoma 1