Streamlining staging of colorectal cancer with Whole Body MRI
Description
Design: Multicentre, prospective diagnostic accuracy study
Aim: This trial evaluated whether early whole-body MRI (WB-MRI) increased per patient sensitivity for metastasis in colorectal cancer compared to standard NICE-approved diagnostic pathways.
Key inclusion/exclusion criteria:
Inclusion: Adult patients with histologically proven or suspected colorectal cancer referred for staging.
Suspicion of colorectal cancer.
Exclusion: Evidence of severe or uncontrolled systemic disease
Contraindications to MRI
Polyp cancer
Primary outcome measure: Per patient sensitivity for metastasis detection by whole body MRI (WB-MRI) compared to standard staging pathways in newly diagnosed colorectal cancer
Secondary outcome measures:
1. The time and test number taken to reach, and the nature of, the first major treatment decision based on WB-MRI in comparison to standard staging pathways.
2. Diagnostic accuracy of WB-MRI and conventional staging pathways for local tumour staging and detection of metastasis in comparison to an expert derived consensus reference standard.
3. Lifetime incremental cost and cost-effectiveness of staging using WB-MRI compared to standard diagnostic pathways.
4. Patient experience of staging using WB-MRI in comparison to standard diagnostic pathways and priorities placed by patients on differing attributes related to competing staging pathways.
5. Inter-observer variability in WB-MRI analysis and effect of diagnostic confidence on staging accuracy.
6. Diagnostic accuracy of limited T1 and diffusion weighted sequences compared to full multi-sequence WB-MRI protocols.
The STREAMLINE-C trial is reported here:
https://www.thelancet.com/journals/langas/article/PIIS2468-1253(19)30056-1/fulltext
