Nav: Home

The Lancet Gastroenterology & Hepatology and The Lancet Respiratory Medicine: Whole body MRI may help to detect spread of cancers more quickly

May 09, 2019

Trials with people with newly-diagnosed colorectal and non-small cell lung cancer suggest that whole body MRI could reduce the time it takes to diagnose the stage of cancers. The results are from two prospective trials with nearly 500 patients across 16 UK hospitals, published in The Lancet Gastroenterology & Hepatology and The Lancet Respiratory Medicine journals.

Whole body MRI scans reduced the average time to determine the size of tumours and how much they had spread by five days for colorectal cancer patients and six days for lung cancer patients. The treatments decided upon were similar, since results from MRI were as accurate as from standard investigations, but the costs per patient were reduced by nearly a quarter in the case of colorectal cancer and were almost halved for lung cancer. More research is needed to determine how this affects outcomes for patients.

Despite their accuracy and efficiency, the authors note that MRI scanners are not as widely available as other imaging technologies and are in high demand. In the trials, many of the hospitals were not able to find time on their MRI scanners, meaning that patients were examined in nearby hospitals.

"Our results, obtained in a real-world NHS setting, suggest that whole body MRI could be more suitable for routine clinical practice than the multiple imaging techniques recommended under current guidelines," says lead author Professor Stuart Taylor from UCL, UK. "While demands on NHS MRI scanners is currently high, MRI can image the whole body in one-hour or less Adopting whole body MRI more widely could save rather than increase costs, as well as reducing the time before a patient's treatment can begin." [1]

Appropriate treatment cannot be decided upon until the size of a tumour and the extent to which it has spread to nearby lymph nodes and other parts of the body has been determined. Standard NHS pathways often involve different imaging techniques - such as CT, PET-CT or focused MRI scans - which vary in accuracy in different organs. Several appointments and follow-up examinations can therefore be necessary.

For the first time, the two new trials compare the diagnostic accuracy and efficiency of whole body MRI with the standard NHS pathways, which use a range of imaging techniques for assessing colorectal and lung cancers. The standard imaging tests recommended by the National Institute for Health and Care Excellence (NICE) [2] were undertaken as usual and the usual multi-disciplinary panel made a first treatment decision based on their results. Once this decision had been recorded, they considered images and reports from whole body MRI. If the latter highlighted a need for further tests, these were carried out. The panel were then able to say whether their first treatment decision would have different based on WB-MRI result. In the interests of patient care, the final decision was made based on results from all tests.

Patients were also followed up after 12 months to better evaluate the accuracy of whole body MRI compared with standard tests. For example, whether one approach was more sensitive than the other in detecting spread of the primary tumour to other parts of the body. Based on this data, the panel were able to retrospectively evaluate what the optimal treatment decision should have been.

Sensitivity and specificity of diagnosis for whole body MRI did not differ from standard tests for both cancers. The use of whole body MRI reduced the time it took to complete diagnostic tests, from an average of 13 days to an average of 8 days in the colorectal cancer trial and from 19 days to 13 days in the lung cancer trial. Costs were reduced from an average of £285 to £216 in the colorectal cancer trial and from an average of £620 to £317 in the lung cancer trial.

In the colorectal cancer trial, agreement with the final multi-disciplinary panel treatment decision based on standard investigations and whole body MRI was similar and high (95% and 96%, respectively), as were results for the lung cancer trial (99% for standard investigations, and 98% for whole body MRI).

Eight of the 16 hospitals in the colorectal cancer trial and 11 of the 16 hospitals in the lung cancer trial did not have the infrastructure to perform whole body MRI.

The authors note that their findings are specific to colorectal and non-small cell lung cancer and might not be relevant to tumours arising in other parts of the body. In addition, waiting times might not be representative of other UK hospitals or of hospitals in other countries. A further limitation of the lung cancer trial is that sensitivity in detecting the spread of cancers - including the development of secondary tumours and the spread to lymph nodes - was low using both current standard imaging techniques and whole body MRI. Further research is needed to improve the performance of non-invasive imaging.

Writing in a linked Comment, Professor Andreas Schreyer from Brandenburg Medical School, Germany, says of the colorectal cancer trial: "MRI has faced considerable backlash within the medical community due to relatively high costs and the problems involved in finding a timely slot for imaging because of the high demand for this method. This is why it is particularly important to think outside the box and look out for new medical pathways and paradigms and not to be driven by prejudices. It could be more efficient to adapt the known therapeutic concept of hitting hard and early to diagnostic imaging to improve medical outcomes and economic performance."
-end-
Peer-reviewed / Observational study / People

NOTES TO EDITORS

The trials were funded by the UK National Institute for Health Research.

[1] Quote direct from author and cannot be found in the text of the Article.

[2] For both lung and colorectal cancer, the UK National Institute for Health and Care Excellence (NICE) provides guidance on staging pathways:

In colorectal cancer, CT of the chest abdomen and pelvis is recommended, supplemented by pelvic MRI for local staging of rectal cancer. In routine clinical practice it is not unusual for patients to undergo PET CT and/or liver MRI if disease spread is suspected.

Staging pathways in lung cancer are more complex, with CT, PET-CT, MRI, US and endobronchial/ percutaneous biopsy all recommended at various points during staging.

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com

IF YOU WISH TO PROVIDE A LINK FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS: http://www.thelancet.com/journals/langas/article/PIIS2468-1253(19)30056-1/fulltext and http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(19)30090-6/fulltext

The Lancet

Related Lung Cancer Articles:

Lung cancer therapy may improve outcomes of metastatic brain cancer
A medication commonly used to treat non-small cell lung cancer that has spread, or metastasized, may have benefits for patients with metastatic brain cancers, suggests a new review and analysis led by researchers at St.
Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Lung transplant patients face elevated lung cancer risk
In an American Journal of Transplantation study, lung cancer risk was increased after lung transplantation, especially in the native (non-transplanted) lung of single lung transplant recipients.
Proposed cancer treatment may boost lung cancer stem cells, study warns
Epigenetic therapies -- targeting enzymes that alter what genes are turned on or off in a cell -- are of growing interest in the cancer field as a way of making a cancer less aggressive or less malignant.
Are you at risk for lung cancer?
This question isn't only for people who've smoked a lot.
Better equipped in the fight against lung cancer
Lung cancer is the third most common type of cancer in Germany and the disease affects both men and women.
New liquid biopsy-based cancer model reveals data on deadly lung cancer
Small cell lung cancer (SCLC) accounts for 14 percent of all lung cancers and is often rapidly resistant to chemotherapy resulting in poor clinical outcomes.
Cancer drug leads to 'drastic decrease' in HIV infection in lung cancer patient
Doctors in France have found the first evidence that a cancer drug may be able to eradicate HIV-infected cells in humans.
Air pollution is associated with cancer mortality beyond lung cancer
A large scale epidemiological study associates some air pollutants with kidney, bladder and colorectal cancer death.
More Lung Cancer News and Lung Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.