Repeat CT-guided biopsy Ok, trial does not support PET-CT in diagnostic pathway of non-diagnostic pleural biopsy

Written By : Dr. Shravani Dali |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2024-02-27T05:00:27+05:30 | Updated On 27 Feb 2024 12:12 PM IST

Repeat CT-guided biopsy Ok, trial does not support PET-CT in diagnostic pathway of non-diagnostic pleural biopsy suggests a new study published in the European Respiratory Journal.

Pleural biopsy is the gold standard for diagnosis of pleural malignancy but a significant proportion will have an inconclusive biopsy despite ongoing clinical suspicion of malignancy. They 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).

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

Repeat CT-guided biopsytrialPET–CTdiagnostic pathwaynon-diagnosticpleural biopsy

Source : European Respiratory Journal

Dr. Shravani Dali

Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751