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.

BMJ open respiratory research [BMJ Open Respir Res] 2025 Jun 01; Vol. 12 (1). Date of Electronic Publication: 2025 Jun 01.

Competing Interests: Competing interests: None declared.
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.
(© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

English

Publisher: BMJ Publishing Group Ltd & British Thoracic Society Country of Publication: England NLM ID: 101638061 Publication Model: Electronic Cited Medium: Internet ISSN: 2052-4439 (Electronic) Linking ISSN: 20524439 NLM ISO Abbreviation: BMJ Open Respir Res Subsets: MEDLINE

Positron Emission Tomography Computed Tomography*/methods , Positron Emission Tomography Computed Tomography*/economics , Lung Neoplasms*/pathology , Lung Neoplasms*/diagnostic imaging , Multiple Pulmonary Nodules*/pathology , Multiple Pulmonary Nodules*/diagnostic imaging , Solitary Pulmonary Nodule*/pathology , Solitary Pulmonary Nodule*/diagnostic imaging , Clinical Decision-Making*/methods , Lung*/pathology , Lung*/diagnostic imaging , Image-Guided Biopsy*/methods, Humans ; Prospective Studies ; Female ; Male ; Middle Aged ; Aged ; Biopsy

20250608