Biopsy decision for intermediate-high-risk lung nodules is significantly changed when guided by prior positron emission tomography/CT (PET/CT) results: results of the prospective PET-FIRST study.
David Fielding, Calvin Sidhu, Mahmoud Alkhater, Moayed Alawami, Stephan E P Kops, Erik H F M van der Heijden, Farzad Bashirzadeh, Morgan Windsor, Elizabeth Nixon, Jung Hwa Son, Niranjan Ananda Setty, David A Pattison, William Fong, Manoj Bhatt, Nattakorn Dhiantravan, Stuart Ramsay, Robert Boots, Michael Putt, Gary Pratt, Catherine Bettington, Roslyn Francis, Paul Thomas, Karin Steinke, Rajesh Thomas
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Abstract
Introduction: Positron emission tomography/CT (PET/CT) may have an important role in guiding decisions regarding biopsy of high-risk lung nodules suspicious for lung cancer. The PET-FIRST study aimed to assess the role of PET/CT prior to any biopsy of a high-risk lung nodule.
Methods: A prospective study was performed in two tertiary hospitals. A study multidisciplinary team (MDT) was established (independent of the hospital Tumour Board) to review referrals of lung nodules with an intermediate-high (≥10%) risk of malignancy by Brock score. A two-stage consensus assessment was undertaken by the MDT regarding choice of biopsy: (1) based on the referral CT alone and then (2) after unblinding the results of PET/CT. The primary study outcome was change in biopsy decision.
Results: 168 patients were included in the study; of these, 53% of nodules were malignant, 44% were benign and 3% cases refused follow-up. In 59 of the 168 patients (35%), the initial recommended biopsy decision was changed based on PET/CT findings. Regarding whether to biopsy the nodule or not, in 42 cases (25%), the initial management decision was changed after PET/CT (p<0.01). Sensitivity analysis showed that the benefit of having PET/CT before nodule biopsy was observed across all ranges of Brock scores. There was an estimated total cost reduction by procedure avoidance of $AA60 796 ($AA362 per patient).
Conclusions: In patients with lung nodules of intermediate-high risk for lung cancer, fluorodeoxyglucose PET/CT performed prior to any biopsy of the nodule has a significant effect in determining biopsy choice.
期刊介绍：
BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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