Performance of DWI in the Nodal Characterization and Assessment of Lung Cancer: A Meta-Analysis

Shen, Guohua; Hu, Shuang; Deng, Hongxin; Kuang, Anren

doi:10.2214/ajr.15.15032

Cited by 31 publications

(22 citation statements)

References 32 publications

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“…For MRI alone, the sensitivity to detect nodal disease was 67% (95% CI 56% to 77%). In their 2016 meta-analysis, which included 1122 participants, Peerlings et al 18 reported that thoracic MRI had 87% (95% CI 78% to 92%) sensitivity for per-patient nodal staging in lung cancer, although Shen et al 19 reported a sensitivity of 68% (95% CI 63% to 73%), which is more consistent with our findings. Indeed, in a study of 113 participants with a histological reference standard, Kim et al 76 reported that morphological MRI observations had a per-patient sensitivity of 68% and a per-nodal station sensitivity of 53%, again very similar to our findings.…”

Section: Diagnostic Accuracysupporting

confidence: 89%

“…[9][10][11][12][13][14][15][16][17][18][19][20] Many have combined multiple cancer types in one single meta-analysis. [9][10][11]13,14,16,17 Those meta-analyses considering the staging of only lung cancer have limited themselves to the detection of bone 12,15 or nodal [18][19][20] metastasis. No meta-analysis has considered colon cancer in isolation, and the largest study to date recruited just 20 participants.…”

Section: Existing Literature On the Diagnostic Accuracy Of Wb-mri In mentioning

confidence: 99%

“…Other (19) Total Appendix 6 Streamline C: reasons for withdrawal of recruited participants 25 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.…”

Section: University Hospital Southampton Nhs Foundation Trustmentioning

confidence: 99%

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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

Taylor

Mallett

Miles

et al. 2019

Health Technol Assess

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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. Trial registration Current Controlled Trials ISRCTN43958015 and ISRCTN50436483. Funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 66. See the NIHR Journals Library website for further project information.

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Section: Diagnostic Accuracysupporting

confidence: 89%

Section: Existing Literature On the Diagnostic Accuracy Of Wb-mri In mentioning

confidence: 99%

Section: University Hospital Southampton Nhs Foundation Trustmentioning

confidence: 99%

See 1 more Smart Citation

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

Taylor

Mallett

Miles

et al. 2019

Health Technol Assess

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“…A previous study demonstrated that DWI has great clinical application value and potential in the differential diagnosis of lung cancer (20). Shen et al (21) suggested that DWI is beneficial in the nodal assessment of patients with lung cancer. Tumor cellular densities increase due to the increase in DWI signals, and the signal intensity and distribution of DWI can represent the number of cancer cells (22).…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted imaging in evaluating the efficacy of concurrent chemoradiotherapy in the treatment of non-small cell lung cancer

Zhang

Shen

et al. 2018

Tumori

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Tumori 2017; 00(00): 000-000 ORIGINAL RESEARCH ARTICLEcountries, although it is decreasing in developed countries. In addition to smoking, sex, nationality, and histology also account for NSCLC (3)(4)(5). Despite advances in standard treatment and early detection, NSCLC is often diagnosed at an advanced stage. Patients typically have poor prognosis, with a 5-year survival rate of less than 15% (6). Concurrent chemoradiotherapy (CCRT) is a new model developed in recent decades. A clinical study reported that the 5-year survival rate of patients with stage III NSCLC receiving CCRT was 15%-25%. This response was clearly better than other treatments, and CCRT was established as the standard treatment for stage III NSCLC (7).Diffusion-weighted imaging (DWI) is a type of functional imaging modality involving magnetic resonance imaging (MRI) (8). Diffusion-weighted imaging characterizes the restriction of the random thermal motion of water molecules within biological tissues and has been applied to the detection and characterization of focal pulmonary lesions (9-12). Diffusionweighted imaging provides quantitative and qualitative functional information about water microscopic movement at the cellular level (13). The apparent diffusion coefficient (ADC) is proposed to qualify differences in water mobility, which reflects the signal loss on DWI (14). The ADC value is inversely associated with tumor cellularity and can potentially be used

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“…25) Recently, the diagnostic capability of MRI has developed and two articles of meta-analysis reported that DWI was effective for the evaluation of N factor of lung cancer. 26,27) Meta-analysis of the MRI by Peerlings et al 26) revealed high diagnostic capability that the sensitivity was 0.87, the specificity 0.88 for nodal assessment in the non-small-cell lung cancer.…”

Section: Resultsmentioning

confidence: 99%

Economic Benefits and Diagnostic Quality of Diffusion-Weighted Magnetic Resonance Imaging for Primary Lung Cancer

Usuda

Funazaki

Maeda

et al. 2017

ATCS

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IntroductionThis paper focuses on the latest research of diffusion-weighted magnetic resonance imaging (DWI), and deals with economic benefits, diagnostic benefits, and prospects of DWI for lung cancer. The medical cost of a magnetic resonance imaging (MRI) is 81%-84% cheaper than that of 18-fluoro-2-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT). DWI is reported to be useful for differential diagnosis of malignancy or benignity for neoplasm in various organs. Diagnostic efficacy by DWI for pulmonary nodules and masses and the evaluation of N factor and M factor in lung cancer are equivalent to or more than that of FDG-PET/CT. The diagnostic capability of wholebody DWI (WB-DWI) for the staging of clinically operable lung cancers is equivalent to that of FDG-PET/CT and brain MRI, and WB-DWI is now becoming a more main stream procedure. Although the diagnostic performance of DWI for lung cancer may be equivalent to that of FDG-PET/CT, prospective randomized controlled trial for comparison of diagnostic efficacy between FDG-PET/CT and DWI for lung cancer is necessary for an accurate comparison. DWI may have an advantage in the aspect of the cost and diagnostic efficacy in lung cancer management.

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Performance of DWI in the Nodal Characterization and Assessment of Lung Cancer: A Meta-Analysis

Abstract: Current evidence suggests that DWI is beneficial in the nodal assessment of patients with lung cancer, and it is necessary to conduct high-quality prospective studies regarding the use of DWI in detecting metastatic lymph nodes of lung cancer to determine its true value.

Cited by 31 publications

References 32 publications

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

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

Diffusion-weighted imaging in evaluating the efficacy of concurrent chemoradiotherapy in the treatment of non-small cell lung cancer

Economic Benefits and Diagnostic Quality of Diffusion-Weighted Magnetic Resonance Imaging for Primary Lung Cancer

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