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BackgroundPleural biopsy is the gold standard for diagnosis of pleural malignancy but a significant proportion will have a inconclusive biopsy despite ongoing clinical suspicion of malignancy. We 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.MethodsThe 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.ResultsBetween September 2015 and September 2018, 59 participants were randomised from 8 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%C.I. 0.83-1.29, p=0.77). The sensitivity of the trial biopsy to identify pleural malignancy was 79% (95%C.I. 54-94%) in the CT-only group versus 81% (95%C.I. 54-96%) in the PET-CT group.InterpretationThe 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.

Original publication

DOI

10.1183/13993003.01295-2023

Type

Journal article

Journal

The European respiratory journal

Publication Date

12/2023

Addresses

Academic Directorate of Respiratory Medicine, The University of Sheffield, UK.