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Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies

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Standard

Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer : the Streamline diagnostic accuracy studies. / Taylor, Stuart A.; Mallett, Susan; Miles, Anne; Morris, Stephen; Quinn, Laura; Clarke, Caroline S.; Beare, Sandy; Bridgewater, John; Goh, Vicky; Janes, Sam; Koh, Dow Mu; Morton, Alison; Navani, Neal; Oliver, Alfred; Padhani, Anwar; Punwani, Shonit; Rockall, Andrea; Halligan, Steve.

In: Health technology assessment (Winchester, England), Vol. 23, No. 66, 01.12.2019, p. 1-269.

Research output: Contribution to journalArticle

Harvard

Taylor, SA, Mallett, S, Miles, A, Morris, S, Quinn, L, Clarke, CS, Beare, S, Bridgewater, J, Goh, V, Janes, S, Koh, DM, Morton, A, Navani, N, Oliver, A, Padhani, A, Punwani, S, Rockall, A & Halligan, S 2019, 'Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies', Health technology assessment (Winchester, England), vol. 23, no. 66, pp. 1-269. https://doi.org/10.3310/hta23660

APA

Taylor, S. A., Mallett, S., Miles, A., Morris, S., Quinn, L., Clarke, C. S., ... Halligan, S. (2019). Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies. Health technology assessment (Winchester, England), 23(66), 1-269. https://doi.org/10.3310/hta23660

Vancouver

Taylor SA, Mallett S, Miles A, Morris S, Quinn L, Clarke CS et al. Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies. Health technology assessment (Winchester, England). 2019 Dec 1;23(66):1-269. https://doi.org/10.3310/hta23660

Author

Taylor, Stuart A. ; Mallett, Susan ; Miles, Anne ; Morris, Stephen ; Quinn, Laura ; Clarke, Caroline S. ; Beare, Sandy ; Bridgewater, John ; Goh, Vicky ; Janes, Sam ; Koh, Dow Mu ; Morton, Alison ; Navani, Neal ; Oliver, Alfred ; Padhani, Anwar ; Punwani, Shonit ; Rockall, Andrea ; Halligan, Steve. / Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer : the Streamline diagnostic accuracy studies. In: Health technology assessment (Winchester, England). 2019 ; Vol. 23, No. 66. pp. 1-269.

Bibtex Download

@article{d2915a76206a4f8989412b9b6c6feaf4,
title = "Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies",
abstract = "Background: Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. Objectives: The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). Design: The design was a prospective multicentre cohort study. Setting: The setting was 16 NHS hospitals. Participants: Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). Interventions: Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography–computed tomography). Reference standard: Consensus panel decision using 12-month follow-up data. Main outcome measures: The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. Results: Streamline C – 299 participants were included. Per-patient sensitivity for metastatic disease was 67{\%} (95{\%} confidence interval 56{\%} to 78{\%}) and 63{\%} (95{\%} confidence interval 51{\%} to 74{\%}) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4{\%} (95{\%} confidence interval –5{\%} to 13{\%}; p = 0.51). Specificity was 95{\%} (95{\%} confidence interval 92{\%} to 97{\%}) and 93{\%} (95{\%} confidence interval 90{\%} to 96{\%}) respectively, a difference of 2{\%} (95{\%} confidence interval –2{\%} to 6{\%}). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96{\%} and 95{\%} of cases, respectively, a difference of 1{\%} (95{\%} confidence interval –2{\%} to 4{\%}). Time for staging was 8 days (95{\%} confidence interval 6 to 9 days) and 13 days (95{\%} confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95{\%} confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95{\%} confidence interval £211 to £221) versus £285 (95{\%} confidence interval £260 to £310). Streamline L – 187 participants were included. Per-patient sensitivity for metastatic disease was 50{\%} (95{\%} confidence interval 37{\%} to 63{\%}) and 54{\%} (95{\%} confidence interval 41{\%} to 67{\%}) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4{\%} (95{\%} confidence interval –7{\%} to 15{\%}; p = 0.73). Specificity was 93{\%} (95{\%} confidence interval 88{\%} to 96{\%}) and 95{\%} (95{\%} confidence interval 91{\%} to 98{\%}), respectively, a difference of 2{\%} (95{\%} confidence interval –2{\%} to 7{\%}). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98{\%} and 99{\%} of cases, respectively, a difference of 1{\%} (95{\%} confidence interval –2{\%} to 4{\%}). Time for staging was 13 days (95{\%} confidence interval 12 to 14 days) and 19 days (95{\%} confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95{\%} confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95{\%} confidence interval £273 to £361) versus £620 (95{\%} confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. Limitations: Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. Conclusions: In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment.",
keywords = "COLONIC NEOPLASMS, COST–BENEFIT ANALYSIS, LUNG NEOPLASMS, MAGNETIC RESONANCE IMAGING, PROSPECTIVE STUDIES, SENSITIVITY AND SPECIFICITY, TECHNOLOGY ASSESSMENT, WHOLE-BODY IMAGING",
author = "Taylor, {Stuart A.} and Susan Mallett and Anne Miles and Stephen Morris and Laura Quinn and Clarke, {Caroline S.} and Sandy Beare and John Bridgewater and Vicky Goh and Sam Janes and Koh, {Dow Mu} and Alison Morton and Neal Navani and Alfred Oliver and Anwar Padhani and Shonit Punwani and Andrea Rockall and Steve Halligan",
year = "2019",
month = "12",
day = "1",
doi = "10.3310/hta23660",
language = "English",
volume = "23",
pages = "1--269",
journal = "Health technology assessment (Winchester, England)",
issn = "1366-5278",
publisher = "NIHR Health Technology Assessment Programme",
number = "66",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer

T2 - the Streamline diagnostic accuracy studies

AU - Taylor, Stuart A.

AU - Mallett, Susan

AU - Miles, Anne

AU - Morris, Stephen

AU - Quinn, Laura

AU - Clarke, Caroline S.

AU - Beare, Sandy

AU - Bridgewater, John

AU - Goh, Vicky

AU - Janes, Sam

AU - Koh, Dow Mu

AU - Morton, Alison

AU - Navani, Neal

AU - Oliver, Alfred

AU - Padhani, Anwar

AU - Punwani, Shonit

AU - Rockall, Andrea

AU - Halligan, Steve

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Background: Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. Objectives: The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). Design: The design was a prospective multicentre cohort study. Setting: The setting was 16 NHS hospitals. Participants: Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). Interventions: Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography–computed tomography). Reference standard: Consensus panel decision using 12-month follow-up data. Main outcome measures: The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. Results: Streamline C – 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval –5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval –2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval –2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L – 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval –7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval –2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval –2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. Limitations: Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. Conclusions: In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment.

AB - Background: Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. Objectives: The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). Design: The design was a prospective multicentre cohort study. Setting: The setting was 16 NHS hospitals. Participants: Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). Interventions: Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography–computed tomography). Reference standard: Consensus panel decision using 12-month follow-up data. Main outcome measures: The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. Results: Streamline C – 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval –5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval –2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval –2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L – 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval –7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval –2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval –2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. Limitations: Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. Conclusions: In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment.

KW - COLONIC NEOPLASMS

KW - COST–BENEFIT ANALYSIS

KW - LUNG NEOPLASMS

KW - MAGNETIC RESONANCE IMAGING

KW - PROSPECTIVE STUDIES

KW - SENSITIVITY AND SPECIFICITY

KW - TECHNOLOGY ASSESSMENT

KW - WHOLE-BODY IMAGING

UR - http://www.scopus.com/inward/record.url?scp=85077005062&partnerID=8YFLogxK

U2 - 10.3310/hta23660

DO - 10.3310/hta23660

M3 - Article

C2 - 31855148

AN - SCOPUS:85077005062

VL - 23

SP - 1

EP - 269

JO - Health technology assessment (Winchester, England)

JF - Health technology assessment (Winchester, England)

SN - 1366-5278

IS - 66

ER -

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