Study on PET-CT in Pleural Biopsy

Repeat CT-guided biopsy is considered acceptable, as a new study published in the European Respiratory Journal suggests that PET-CT is not supported in the diagnostic pathway of non-diagnostic pleural biopsy.

Pleural biopsy is the gold standard for diagnosing pleural malignancy, but a significant proportion of cases result in inconclusive biopsies despite ongoing clinical suspicion of malignancy. The study investigated whether positron emission tomography-computed tomography (PET-CT) targeted pleural biopsy is superior to standard CT-guided pleural biopsy following an initial non-diagnostic biopsy.

The TARGET trial was a multicentre, parallel group randomised trial. Patients with a previous inconclusive pleural biopsy but an ongoing suspicion of pleural malignancy were randomised (1:1) to receive either CT-guided biopsy (standard care) or PET-CT followed by a targeted CT biopsy (intervention).

Primary Outcome

The primary outcome was pleural malignancy correctly identified from the trial biopsy.

Results

Between September 2015 and September 2018, 59 participants were randomised from eight UK hospital sites: 29 to CT-only followed by targeted biopsy and 30 to PET-CT followed by targeted biopsy. The proportion of pleural malignancy correctly identified was similar between the groups (risk ratio 1.03 (95% CI 0.83–1.29); p=0.77). The sensitivity of the trial biopsy to identify pleural malignancy was 79% (95% CI 54–94%) in the CT-only group versus 81% (95% CI 54–96%) in the PET-CT group.

The results do not support the practice of PET-CT to guide pleural biopsies in patients with a previous non-diagnostic biopsy. The diagnostic sensitivity in the CT-only group was higher than anticipated and supports the practice of repeating a CT-guided biopsy following an inconclusive result if clinical suspicion of malignancy persists.

Reference

Duneesha de Fonseka, David T. Arnold, Helena J.M. Smartt, Lucy Culliford, Louise Stadon, Emma Tucker, Anna Morley, Natalie Zahan-Evans, Anna C. Bibby, Geraldine Lynch, Eleanor Mishra, Shahul Khan, Mohammed Haris, Henry Steer, Leon Lewis, Alina Ionescu, John Harvey, Kevin Blyth, Najib M. Rahman, Anthony E. Edey, Chris A. Rogers, Nick A. Maskell. European Respiratory Journal 2024 63: 2301295; DOI: 10.1183/13993003.01295-2023