In a ground-breaking international study, researchers at the Wesley-St Andrew’s Research Institute (WSARI) in Brisbane are launching a trial into a new MRI technique that could for the first time accurately identify cancerous lymph nodes.

While MRI can pinpoint cancer in major organs, specialists have had less success identifying lymph nodes to where cancer cells may have spread.

The new “Nano” MRI technique to be trialled on prostate cancer patients involves injecting small iron particles into the bloodstream. When an MRI is performed 24 hours later cancerous lymph nodes light up white while normal lymph nodes show up black on the MRI image.

The research is a partnership between WSARI researchers, urologists Dr Les Thompson and Dr Morgan Pokorny, radiologists, Dr Nick Brown, Dr David Wong and Dr Darren Ault,  together with Professor Jelle Barentsz and his team from the Radboud University Nijmegen Medical Center, in the Netherlands.

A $1.5million fundraising drive for the project was launched at the Wesley-St Andrew’s Research Institute’s 21^st anniversary gala evening in Brisbane on Saturday May 23.

“Advances in MRI technology and other treatments are significant in fighting cancer, but frequently healthy lymph nodes are removed while cancerous ones are spared because we haven’t had the images to detect the difference,” said Dr Thompson.

The MAGNIFI trial[1], to be conducted on high-risk prostate cancer patients at The Wesley Hospital, will be launched later this year. The research will compare the current best practice approach to prostate cancer screening - known as the PSMAGa68 PET scan - with the new Nano-MR technique, as well as analysing the pathology of the lymph nodes.

The current guidelines for prostate cancer treatment in high-risk patients are to remove both the prostate and lymph nodes. All trial patients will undergo both Nano MRI and PSMAGa68 PET scans, as well as lymph node removal which will be done robotically.

“We already know that the majority of lymph nodes removed during prostate cancer operations are not cancerous. We are not certain of the accuracy of lymph node imaging and this study aims to find this out,” Dr Thompson said.

 “We now have anatomical  (the Nano MRI) and functional (PET scan) imaging for lymph nodes and we’ll be able to find out which is the best way to image cancer in the lymph nodes.

 “We expect this will avoid some unnecessary operations on the lymph nodes in future and hopefully, accurate diagnosis and treatment may prevent recurrences of cancer.

“We are starting the work with prostate cancer but we can extend it to other areas like breast, melanoma and head and neck cancer.”

Complications from lymph node removal include a risk of developing an infection and a build-up of fluid in the legs and arms which often need long-term treatment.

Dr Thompson said the research was commencing with prostate cancer because of the success of past research collaborations with Netherlands-based Professor Barentsz.

In 2013, a clinical trial conducted by the Australian and Dutch researchers found that Professor Barentsz’s multi-parametric MRI technique significantly improved diagnosis of life-threatening prostate cancer while reducing over-diagnosis of non-life-threatening cases.

The two-year study published in the journal European Urology[2] found that use of multi-parametric MRI (mpMRI) reduced the number of men needing prostate biopsies by 51% and reduced the problem of over-diagnosis of non-life threatening disease by about 90%.

 “Our past work has significantly changed the diagnostic techniques of prostate cancer and reduced the number of cases requiring biopsies. The multi-parametric MRI solved a significant problem, now we are tackling the next frontier: the lymph nodes.”

Professor Christian Gericke, CEO and Director of Research of the WSARI, said the research was an example of 21 years of research leadership.

“The Wesley St Andrew’s Research Institute has become a leader in clinical research, helping patients through improved diagnosis methods, new treatment options and increased quality of life post-treatment for many conditions. We are hoping to raise significant support for this important new research.”

[1] Metastasis assessment with Gallium-68 PSMA and Nanoparticle Imaging Fusion International

 [2]“Prospective Study of Diagnostic Accuracy Comparing Prostate Cancer Detection by Transrectal Ultrasound–Guided Biopsy Versus Magnetic Resonance (MR) Imaging with Subsequent MR-guided Biopsy in Men Without Previous Prostate Biopsies, European Urology, July 2014.

Watch the Nine News segment on the world-first MRI lymph node cancer trial