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Whole-body MRI as an alternative staging strategy in non-small cell lung cancer
Accurate and efficient diagnostic pathways are essential in non-small cell lung cancer (NSCLC) staging as site and spread of disease typically dictate therapeutic options. Taylor et al (Lancet Respir Med 2019;7:523) prospectively evaluated the diagnostic accuracy for metastatic disease of staging pathways based on whole-body MRI (WB-MRI), compared with standard multimodality pathway in cases of newly diagnosed, but potentially radically treatable NSCLC. The Streamline L trial was implemented in 16 UK centres which screened 976 patients, recruiting 353 with 187 completing the trial protocol. Participants underwent WB-MRI in addition to standard staging investigations. Radiologists blinded to patients’ clinical history (other than suspected cancer diagnosis) and contemporaneous imaging reported on local tumour stage and distant metastases. The local multidisciplinary team made the first major treatment decision based on standard investigations. The WB-MRI was then reviewed as if it were the initial staging investigation: any additional investigations deemed necessary were performed or reviewed to stage disease and decide on treatment. Compared with a reference standard established from a multidisciplinary consensus panel there was no significant difference in sensitivity for metastatic disease (n=52; WB-MRI 50% (95% CI 37 to 63), standard 54% (41 to 67), difference −4% …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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