Randomised controlled trial to compare the diagnostic yield of Positron Emission Tomography Computed Tomography (PET-CT) TARGETed pleural biopsy versus CT-guided pleural biopsy in suspected pleural malignancy

Sponsor: NIHR/RfPB

Sponsor: North Bristol NHS Foundation Trust

Funder: National Institute for Health and Research (NIHR) Research for patient benefit (RFPB).

REC Number: 15/SW/0156

Many patients with a history of asbestos exposure can develop irregular thickening of the lung lining (the pleura). Although in many cases the pleural thickening is not serious, a small proportion of patients can develop cancer of the lung lining (mesothelioma). Chest X-rays and CT (computed tomography) scans of these patients can indicate a suspicion of cancer but the only way to confirm the diagnosis is by obtaining a sample (biopsy) from the lung lining and examining the cells.

Sometimes the biopsy does not give us the answer, so a second biopsy may be needed. Unfortunately, it is common that this second biopsy also does not give a clear answer either. If it is possible to target the biopsy to the right part of the lung lining more accurately, it may be possible to give a more definite diagnosis.

A scan called Positron Emission Tomography Computed Tomography (or PET-CT) highlights areas where the cells are more active. Cancer cells are usually more active than normal cells. Therefore a PET-CT scan may show us the best place to take the biopsy in order to establish if there are cancer cells. PET scanners are expensive and in high demand so high-quality evidence is required before they can be used routinely for this purpose.

The TARGET study will investigate how effective PET-scan targeted tissue sampling is compared to the conventional CT targeted sampling in patients requiring a second biopsy for suspected mesothelioma. The study will aim to recruit 78 patients in total across a number of UK hospitals and will compare the results in two groups of patients who have been randomly allocated to one or the other method.

Contact Information

Chief Investigator: Professor Nick Maskell, Academic Respiratory Unit, Southmead Hospital