Radio daignosis

The study find that the Whole-body MRI is more efficient and less costly than standard methods use to stage colorectal cancer and non–small cell lung cancer (NSCLC), and accuracy is similar, according to new findings. For colorectal cancer, the time it took to complete diagnostic tests was reduced from an average of 13 days using standard multimodal diagnostics to an average of 8 days using WB-MRI. For NSCLC, the time is reduce from 19 days to 13 days.

Standard multimodal diagnostics

Importantly, for both cancers, WB-MRI did not differ significantly from standard tests in diagnostic sensitivity and specificity. “They find the accuracy of WB-MRI was not significantly different from standard multiscan staging pathways; but WB-MRI pathways are quicker and cheaper in an NHS [National Health Service] setting;” said Stuart Taylor, MD, from University College London; United Kingdom.

“They therefore conclude that WB-MRI is a viable first-line staging test, and the studies are carefully consider by expert bodies such as NICE [National Institute for Health Care and Excellence] who issue guidance on NHS practice.” Taylor; who was lead author on both studies; told Medscape Medical News that the radiologists reporting on WB-MRI were representative of those who would “report it were it to be more widely disseminated; as we did not use a handful of very expert radiologists who would not be representative of usual clinical care.”

Usual clinical care

The study of the use of WB-MRI for colorectal cancer is publish online May 9 in the Lancet Gastroenterology and Hepatology. The study of WB-MRI for NSCLC is publish May 9 in the Lancet Respiratory Medicine. Accurate staging is imperative to ensure optimal patient outcomes and particularly to identify metastatic disease so as to determine the therapeutic strategy.

But staging pathways are complex and rely on high-technology imaging platforms, such as CT, positron-emission tomographic CT (PET-CT); and MRI. In England, where both studies were conduct; the NICE publishes guidelines that indicate multiple sequential imaging tests for staging and for making decisions regarding initial treatment.

The same investigators conduct both studies, which are parallel prospective multicenter trials design to directly compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with the current standard in NSCLC (Streamline L) and colorectal cancer (Streamline C).

Multicenter trials designed

The Streamline C trial was conducted in 16 hospitals in England; 299 patients complete the study. Of this group; 68 (23%) had metastasis at baseline. The protocol was for patients to undergo WB-MRI; with the result being withheld until standard staging is complete and the first treatment decision was made.
The healthcare providers then recorded their treatment decision first on the basis of standard investigations; and then on the basis of the results of the WB-MRI staging pathway; and finally on the basis of all tests. The primary outcome was the difference in sensitivity for metastases between the standard staging pathway and the WB-MRI staging pathway with regard to a consensus reference standard at 12 months.