Streamlining staging of lung and colorectal cancer with whole body MRI; study protocols for two multicentre, non-randomised, single-arm, prospective diagnostic accuracy studies (Streamline C and Streamline L)

Research output: Contribution to journalArticlepeer-review


  • Stuart A Taylor
  • Anne Miles
  • Sandy Beare
  • Gauraang Bhatnagar
  • John Bridgewater
  • Rob Glynne-Jones
  • Vicky Goh
  • Ashley M Groves
  • Sam M Janes
  • Dow Mu Koh
  • Steve Morris
  • Alison Morton
  • Neal Navani
  • Alf Oliver
  • Anwar R Padhani
  • Shonit Punwani
  • Andrea G Rockall
  • Steve Halligan

Colleges, School and Institutes

External organisations

  • University College London
  • School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
  • Birkbeck, University of London
  • Cancer Research UK & UCL Cancer Trials Centre, 90 Tottenham Court Road, London, W1T 4TJ, UK.
  • UCL Cancer Institute, Paul O Gorman Building, 72 Huntley Street London, London, WC1E 6DD, UK.
  • Mount Vernon Centre for Cancer Treatment, Rickmansworth Road, Northwood, MIDDX, HA6 2RN, UK.
  • Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering Kings College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
  • Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK.
  • C/O National Cancer Research Institute, 407 St Johns Street, London, EC1V 4AD, UK.
  • Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK.
  • Department of Radiology, Royal Marsden NHS Foundation Trust, Fulham Rd London, London, SW3 6JJ, UK.


BACKGROUND AND AIMS: Rapid and accurate cancer staging following diagnosis underpins patient management, in particular the identification of distant metastatic disease. Current staging guidelines recommend sequential deployment of various imaging platforms such as computerised tomography (CT) and positron emission tomography (PET) which can be time and resource intensive and onerous for patients. Recent studies demonstrate that whole body magnetic resonance Imaging (WB-MRI) may stage cancer efficiently in a single visit, with potentially greater accuracy than current staging investigations. The Streamline trials aim to evaluate whether WB-MRI increases per patient detection of metastases in non-small cell lung and colorectal cancer compared to standard staging pathways.

METHODS: The Streamline trials are multicentre, non-randomised, single-arm, prospective diagnostic accuracy studies with a novel design to capture patient management decisions during staging pathways. The two trials recruit adult patients with proven or highly suspected new diagnosis of primary colorectal (Streamline C) or non-small cell lung cancer (Streamline L) referred for staging. Patients undergo WB-MRI in addition to standard staging investigations. Strict blinding protocols are enforced for those interpreting the imaging. A first major treatment decision is made by the multi-disciplinary team prior to WB-MRI revelation based on standard staging investigations only, then based on the WB-MRI and any additional tests precipitated by WB-MRI, and finally based on all available test results. The reference standard is derived by a multidisciplinary consensus panel who assess 12 months of follow-up data to adjudicate on the TNM stage at diagnosis. Health psychology assessment of patients' experiences of the cancer staging pathway will be undertaken via interviews and questionnaires. A cost (effectiveness) analysis of WB-MRI compared to standard staging pathways will be performed.

DISCUSSION: We describe a novel approach to radiologist and clinician blinding to ascertain the 'true' diagnostic accuracy of differing imaging pathways and discuss our approach to assessing the impact of WB-MRI on clinical decision making in real-time. The Streamline trials will compare WB-MRI and standard imaging pathways in the same patients, thereby informing the most accurate and efficient approach to staging.

TRIAL REGISTRATION: Streamline C ISRCTN43958015 (registered 25/7/2012). Streamline L ISRCTN50436483 (registered 31/7/2012).


Original languageEnglish
Article number299
JournalBMC Cancer
Publication statusPublished - 2 May 2017


  • Colorectal cancer, Lung cancer, Staging, Computed tomography, Whole body magnetic resonance imaging, Positron emission tomography, Patient experience