Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial

Taylor, S.A. and Mallett, S. and Beare, S. and Bhatnagar, G. and Blunt, D. and Boavida, P. and Bridgewater, J. and Clarke, C.S. and Duggan, M. and Ellis, S. and Glynne-Jones, R. and Goh, V. and Groves, A. and Hameeduddin, A. and Janes, S.M. and Johnson, E. and Koh, D.-M. and Miles, Anne and Morris, S. and Morton, A. and Navani, N. and O'Donohue, J. and Oliver, A. and Padhani, A. and Pardoe, H. and Patel, U. and Punwani, S. and Quinn, L. and Rafiee, H. and Reczko, K. and Rockall, A. and Shahbuddin, K. and Teague, J. and Thaha, M. and Train, M. and Van Ree, K. and Sidhu, H. and Wijeyekoon, S. and Halligan, S. (2019) Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterology and Hepatology 4 (7), pp. 529-537. ISSN 2468-1253.

Abstract

Background: Whole-body magnetic resonance imaging(WB-MRI) may be an alternative to multi-modality staging of colon cancer but its relative diagnostic accuracy, effect on staging times, test number, cost, and impact on treatment decisions are unknown. We undertook a prospective multicentre cohort study to address this (ISRCTN43958015). Methods: We recruited from 16 English hospitals. Eligible patients were 18 years or older, with newly diagnosed colon cancer. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete. The multi-disciplinary team (MDT) recorded its first treatment decision based on standard investigations, then the alternate WB-MRI staging pathway (WB-MRI plus any additional tests generated), and finally on all tests combined. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12-months. Differences in treatment decisions, staging time, test number, and costs were secondary outcomes. Findings: 299 patients completed the trial; 68 (23%) had metastasis at baseline. The WB-MRI pathway was 68% (95% CI 56 to 78) sensitive, not significantly different from standard pathways (63% [51 to 74]), a 4% (-5 to 13) difference, p=0.508. Specificity was not significantly different (95% [92 to 97], vs. 94% [90 to 96]). Agreement with the MDT final treatment decision was 96% and 95% for WB-MRI and standard pathways respectively. Time to complete staging was significantly shorter for WB-MRI (8 days [6 to 9] vs. 13 days [11 to 15]), a 5-day (3 to 7) difference. WB-MRI pathways required significantly fewer tests (median 1 [1 to 1] vs. 2 [2 to 2]), a difference of 1 (1 to 1). Mean per-patient staging costs were £216 and £285 for WB-MRI and standard pathways respectively. Interpretation: WB-MRI staging pathways are as accurate as standard pathways, but reduce tests, staging time, and cost.

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