Diagnostic accuracy for metastatic disease in lung and colorectal cancer: prospective comparison of whole-body MRI with standard pathways- Streamline Trials

Research output: Contribution to journalArticle

Authors

Colleges, School and Institutes

External organisations

  • University College London
  • UNIVERSITY COLLEGE LONDON HOSPITALS
  • UCL

Abstract

Background: Whole-body magnetic resonance imaging (WB-MRI) is advocated as an alternative to standard pathways for staging cancer.

Objectives: To compare diagnostic accuracy, efficiency, patient acceptability, observer variability, and cost effectiveness of WB-MRI and standard pathways in staging newly diagnosed non-small cell lung cancer (Streamline L) and colorectal cancer (Streamline C)

Design: Prospective multicentre cohort study

Setting: Sixteen NHS hospitals

Participants: Consecutive patients ≥18 years, with histologically proven or suspected colorectal (Streamline C) or non-small cell lung cancer (Streamline L)

Tests: WB-MRI. Standard staging investigations e.g. CT and PET-CT

Reference standard: Consensus panel decision using 12 months follow up

Main outcome measures: Primary outcome; per-patient sensitivity difference between WB-MRI and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, nature of the first major treatment decision, time and test number to complete staging, patient experience, and cost effectiveness.

Results: Streamline C- 299 patients were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56 to 78), and 63% (51 to 74) for WB-MRI and standard pathways respectively, a difference in sensitivity of 4% (-5 to 13), p=0.51. Specificity was 95% (92 to 97) and 93% (90 to 96) respectively, a difference of 2 % (-2 to 6). Treatment decisions agreed with the multi-disciplinary team (MDT) treatment decision in 96% and 95% respectively, a difference of 1% (-2 to 4). Time for staging was 8 (6 to 9) and 13 (11 to 15) days for WB-MRI and standard pathways respectively, a difference of 5 (3 to 7) days. The WB-MRI pathway was cheaper than the standard staging pathway £216 (95% CI 211 to 221) vs £285 (260 to 310).

Streamline L- 187 patients were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37 to 63), and 54% (41 to 67) for WB-MRI and standard pathways respectively, a difference in sensitivity of 4% (-7 to 15), p=0.73. Specificity was 93% (88 to 96) and 95% (91 to 98) respectively, a difference of 2 % (-2 to 7). Treatment decisions agreed with the multi-disciplinary team (MDT) treatment decision in 98% and 99% respectively, a difference of 1% (-2 to 4). Time for staging was 13 (12 to 14) and 19 (17 to 21) days for WB-MRI and standard pathways respectively, a difference of 6 (4 to 8) days. The WB-MRI pathway was cheaper than the standard staging pathway £317 (273 to 361) vs. £620 (574 to 666).

Patients generally found WB-MRI more burdensome than standard imaging but most preferred WB-MRI staging pathways if they reduced time to staging and/or test number.

Limitations: WB-MRI was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice

Conclusions: In colorectal and non-small cell lung cancer, WB-MRI staging pathways have similar accuracy to standard staging, are generally preferred by patients, improve staging efficiency, and have lower staging costs.

Future work: Utility of WB-MRI for treatment response assessment

Study registration: ISRCTN 43958015 and 50436483

Funding details:NIHR Health Technology Assessment Programme

Details

Original languageEnglish
JournalHealth Technology Assessment
Publication statusPublished - 1 Dec 2019