Whole-body MRI staging quicker and cheaper than standard pathways in NSCLC
medwireNews: The Streamline L trial has found that in patients with newly diagnosed non-small-cell lung cancer (NSCLC), a staging pathway using whole-body magnetic resonance imaging (WB–MRI) has similar accuracy but a shorter time to complete staging and lower mean per-patient costs versus standard pathways.
In fact, say Stuart Taylor (University College London, UK) and co-researchers in The Lancet Respiratory Medicine: “Our data suggest WB–MRI is a viable replacement for standard pathways.”
The WB–MRI-based staging pathway had similar accuracy in detecting metastatic disease as patient review by a multidisciplinary team of radiologists and other physicians considering imaging, biopsy, and surgical findings and clinical course, with a sensitivity of 50% versus 54% and specificity of 93% versus 95%, respectively. Accordingly, the two pathways resulted in similar treatment decisions from a multidisciplinary team.
However, the time to complete staging was 6 days faster with WB–MRI, at 13 versus 19 days for the standard pathway. In addition, the mean per-patient costs were lower for the WB–MRI pathway, at a mean of £317 (€ 367, US$ 413) compared with £620 (€ 718, $ 808) for the standard pathway.
Of note, the researchers used a routine clinical practice setting in which 16 radiologists interpreted the WB–MRI results, with procedures that the researchers describe as “designed specifically to mirror how WB-MRI would be reported in [UK National Health Service] practice if more widely disseminated.”
They add: “Although patients report that having WB-MRI is a greater burden than standard imaging, a [previously reported] discrete choice experiment done as part of the trial shows patients generally prefer WB-MRI staging to standard pathways if they reduce staging times and radiation exposure as found in Streamline L.”
There were some differences in favor of the standard pathway, however, such as greater sensitivity in those with metastatic disease of less than 1 cm (27 vs 9% for WB–MRI) and significantly greater agreement for lymph node staging (75 vs 65%), although this difference “did not negatively affect treatment decisions,” the team says.
In an associated comment, Mathias Meyer and Johannes Budjan (both from Heidelberg University, Mannheim, Germany) describe the Streamline L study as “a step in the right direction” but note that difficulties remain, including the low sensitivity of both pathways for metastatic staging, the poor results with WB–MRI versus standard pathways for lymph node staging, contraindications to WB–MRI such as claustrophobia, and the use of gadolinium-based contrast agents.
“Further research is needed to improve the diagnostic performance of non-invasive imaging, preferably a one-stop-shop approach, which allows time-efficient and accurate treatment decisions,” they conclude.
By Catherine Booth
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