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Lung NoduleVERITASNCT04250194

Navigation Endoscopy to Reach Indeterminate Lung Nodules Versus Trans-Thoracic Needle Aspiration

A study testing CT-Guided Biopsy and Navigation bronchoscopy in people with Lung Nodule, run by Vanderbilt-Ingram Cancer Center at 7 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study will evaluate which procedure is the best for patients referred for biopsy of a lung nodule (growth in the lung) meeting the size and location requirements of the protocol. Two different procedures are available for lung nodule biopsy: 1. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Lung Nodule
What is being tested?
CT-Guided Biopsy and Navigation bronchoscopy
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
288 participants
Where
7 sitesUnited States
Study dates
22 May 2020to 2 Jul 2024
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient is referred for biopsy of a single indeterminate pulmonary nodule, with the following characteristics regarding size, location, accessibility, and probability of malignancy:
  • Intermediate pre-test probability of malignancy as defined by a pre-test probability of malignancy between 10% and 100%, using a validated clinical prediction model, which is either:
  • The Brock model14 if no PET scan data are available, or
  • The Herder model15 if PET-CT data are available.
  • Size between 10 and 30 mm (long diameter).
  • Location peripheral, here defined as occupying the middle or outer third lung zones.
  • Accessible via navigation bronchoscopy and also accessible via CT-guided biopsy (i.e. the nodule is clinically suited to equal access by either procedure), as confirmed by an independent interventional panel.

Who cannot join

  • Patients with proximal nodules, as defined by nodules present in the proximal 1/3 of the lung by dedicated software analysis (described below) will not be eligible for the study.
  • Patients with multiple nodules requiring biopsy (patients may have other nodules not considered for biopsy).

Trial locations and contacts

7 sites in 1 country.

7 sites in 1 country

United States7 sites
  • Rush University Medical Center

    Chicago, Illinois, 60612

  • Kootenai Health

    Coeur d'Alene, Idaho, 83814

  • Duke University Medical Center

    Durham, North Carolina, 27710

  • Saint Luke's Hospital of Kansas City

    Kansas City, Missouri, 64111

  • Medical College of Wisconsin

    Milwaukee, Wisconsin, 53226

  • Vanderbilt-Ingram Cancer Center

    Nashville, Tennessee, 37232

  • University of California, San Diego

    San Diego, California, 92037

Other trials in United States

About this study

Official title: Navigation Endoscopy to Reach Indeterminate Lung Nodules Versus Trans-Thoracic Needle Aspiration, a Randomized Controlled Study (VERITAS)

This study will evaluate which procedure is the best for patients referred for biopsy of a lung nodule (growth in the lung) meeting the size and location requirements of the protocol. Two different procedures are available for lung nodule biopsy:

  1. a computed tomography guided biopsy ("CT-guided biopsy") which consists of sampling the nodule from the "outside-in", through the chest wall with CT guidance, and
  2. navigation bronchoscopy, which is a procedure using technology designed to guide a catheter through the natural airway route (wind-pipe and bronchi) to access the nodule.
Read the detailed description

Endpoints:

Primary:

  • To evaluate diagnostic accuracy through 12 months of clinical follow-up

Secondary:

  • To evaluate rate of pneumothorax.
  • To evaluate rate of pneumothorax requiring chest tube placement.
  • To evaluate clinically significant bleeding (defined by bleeding requiring intervention).
  • To evaluate need for hospitalization after procedure.
  • To evaluate duration of the procedure.
  • To evaluate procedural factors associated with improved yield (type of biopsy, number of biopsies, use of radial ultrasound, presence of a bronchus sign, biopsy site).
  • To evaluate need for additional nodule biopsy.
  • To evaluate need for additional procedure for staging.
  • To evaluate radiation exposure from fluoroscopy-guided bronchoscopy and CT for CT-guided biopsy.
  • To evaluate need for F-Nav (digital tomosynthesis) during navigation bronchoscopy.
  • To evaluate diagnostic yield
  • To evaluate the rate at which the biopsy procedure yields a confident clinical diagnosis (including any added yield from endobronchial ultrasound-guided mediastinal and/or hilar lymph node biopsies or microbiologic studies which yield an explanation for a nodule despite non-diagnostic biopsy specimens).
Conditions
Lung Nodule
Being tested
CT-Guided Biopsy, Navigation bronchoscopy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CT-Guided BiopsyDevice

    Images will be generated by a CT scanner to accurately insert a needle into the lung nodule allowing a sample to be removed for testing

  • Navigation bronchoscopyDevice

    A virtual three-dimensional map of the lung will be generated enabling the physician to perform an anatomically precise biopsy

Study groups in NCT04250194
Study groupRoleWhat they receive
Navigation Bronchoscopy (NB) with F-NavExperimentalNot described
Receives: Device: Navigation bronchoscopy
CT-guided BiopsyExperimentalNot described
Receives: Device: CT-Guided Biopsy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Diagnostic Accuracy

    Proportion of biopsies leading to a definitive diagnosis, comparing the bronchoscopy pathway to the CT-guided biopsy pathway. Definitive diagnoses are pre-defined as any of the following:

    • Malignant, OR
    • Abnormal tissue (excluding normal or absence of lung parenchyma) followed by a surgical lung biopsy yielding the same histological diagnosis, OR
    • Specific benign histopathologic finding which accounts for the presence of a lung nodule (specifically including organizing pneumonia, frank purulence, granulomatous inflammation, or other specific benign finding) AND
    • Absence of malignancy (true negative) through 1-year CT follow-up, defined as:
    • The nodule markedly regresses or resolves on follow-up imaging, OR
    • A persistent nodule has not been diagnosed as malignant, AND
    • No plans for repeat invasive diagnostic procedures through 12 months follow-up.

    Normal or absence of lung parenchyma, atypia and non-specific inflammation will be considered non-diagnostic.

    Measured: Up to 12 months

Secondary outcomes (17)
  1. Diagnostic Yield

    Rate at which histopathology is obtained which explains the presence of a nodule (according to definitions set forth for the primary endpoint) and permits post-biopsy clinical decision-making without need for immediate additional diagnostic procedures.

    Measured: Up to 12 months

  2. Rate of Pneumothorax

    Proportion of cases complicated by pneumothorax

    Measured: Up to 12 months

  3. Rate of Pneumothorax Requiring Chest Tube Placement

    Proportion of cases complicated by pneumothorax requiring chest tube placement

    Measured: Up to 12 months

  4. Need for Hospitalization After Procedure

    Proportion of cases with complication necessitating hospitalization after a procedure

    Measured: Up to 12 months

  5. Duration of Procedure

    Total time required to complete the procedure

    Measured: Up to 12 months

  6. Procedural Factors Associated With Improved Yield (Type of Biopsy)

    Association of diagnostic yield with type of tools used to obtain biopsy: F-Nav Bronchoscopy group. This outcome measure is only applicable to the patients randomized to the navigational bronchoscopy platform.

    Measured: Up to 12 months

  7. Procedural Factors Associated With Improved Yield (Number of Biopsies)

    Association of diagnostic yield with count of biopsies. This outcome measure is only specific to the F-Nav bronchoscopy arm.

    Measured: Up to 12 months

  8. Procedural Factors Associated With Improved Yield (Use of Radial Ultrasound)

    Association of diagnostic yield with use of radial ultrasound. This outcome measure is only specific to the F-Nav bronchoscopy arm.

    Measured: Up to 12 months

  9. Procedural Factors Associated With Improved Yield (Presence of a Bronchus Sign)

    Association of diagnostic yield with presence of a bronchus sign

    Measured: Up to 12 months

  10. Procedural Factors Associated With Improved Yield (Biopsy Site)

    Association of diagnostic yield with biopsy site (nodule location)

    Measured: Up to 12 months

  11. Need for Additional Nodule Biopsy

    Proportion of cases in which additional invasive biopsy procedures directed at the targeted nodule were subsequently performed

    Measured: Up to 12 months

  12. Need for Additional Procedure for Staging

    Proportion of cases in which a subsequent procedure was performed for staging

    Measured: Up to 12 months

  13. Radiation Exposure From Fluoroscopy-guided Bronchoscopy

    Count of total radiation exposure from fluoroscopy-guided bronchoscopy (units mGy*cm^2)

    Measured: Up to 12 months

  14. Need for F-Nav During Navigation Bronchoscopy

    Count of instances of need for F-Nav (digital tomosynthesis) during navigation bronchoscopy. This outcome measure pertains only for the F-Nav bronchoscopy arm.

    Measured: Up to 12 months

  15. Confident Clinical Diagnosis

    The proportion of biopsy procedures yielding a confident clinical diagnosis including any added yield from endobronchial ultrasound-guided mediastinal and/or hilar lymph node biopsies or microbiologic studies which yield an explanation for a nodule despite non-diagnostic biopsy specimens.

    Measured: Up to 12 months

  16. Radiation Exposure From CT for CT-guided Biopsy

    Count of total radiation exposure CT-guided transthoracic biopsy (units of mGy*cm)

    Measured: Up to 12 months

  17. Procedural Factors Associated With Improved Yield (Type of Biopsy): CT-guided Group

    Association of diagnostic yield with type of tools used to obtain biopsy: CT-guided group. This outcome measure is only applicable to the patients randomized to the CT-guided procedure.

    Measured: Up to 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Jan 2020
  2. Study start22 May 2020
  3. Primary completion10 Jun 2024
  4. Study completion2 Jul 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
288 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04250194
Sponsor's protocol ID
VICC THO 19102
Other IDs
NCI-2020-00632
Acronym
VERITAS
Status last verified
Sep 2025
First submitted
29 Jan 2020
Last updated
29 Sep 2025
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes

Publications

  • Lentz RJ, Frederick-Dyer K, Planz VB, Koyama T, Aboudara MC, Swanner B, Roller L, Low SW, Salmon C, Avasarala SK, Hoopman TC, Wahidi MM, Mahmood K, Cheng GZ, Katsis JM, Kurman JS, D'Haese PF, Johnson J, Grogan EL, Walston C, Yarmus L, Silvestri GA, Rickman OB, Rahman NM, Maldonado F; Interventional Pulmonary Outcomes Group. Navigational Bronchoscopy vs CT Scan-Guided Transthoracic Needle Biopsy for the Diagnosis of Indeterminate Lung Nodules: Protocol and Rationale for the Navigation Endoscopy to Reach Indeterminate Lung Nodules vs Transthoracic Needle Aspiration, a Randomized Controlled Study Multicenter Randomized Trial. CHEST Pulm. 2024 Mar 19;2(3):100050. doi: 10.1016/j.chpulm.2024.100050. eCollection 2024 Sep.

    PubMed 42548449
  • Lentz RJ, Frederick-Dyer K, Planz VB, Koyama T, Aboudara MC, Avasarala SK, Casey JD, Cheng GZ, D'Haese PF, Duke JD, Grogan EL, Hoopman TC, Johnson J, Katsis JM, Kurman JS, Low SW, Mahmood K, Rickman OB, Roller L, Salmon C, Shojaee S, Swanner B, Wahidi MM, Walston C, Silvestri GA, Yarmus L, Rahman NM, Maldonado F; Interventional Pulmonary Outcomes Group. Navigational Bronchoscopy or Transthoracic Needle Biopsy for Lung Nodules. N Engl J Med. 2025 Jun 5;392(21):2100-2112. doi: 10.1056/NEJMoa2414059. Epub 2025 May 18.

    PubMed 40387025
  • Lentz RJ, Frederick-Dyer K, Planz VB, Koyama T, Aboudara MC, Swanner B, Roller L, Low SW, Salmon C, Avasarala SK, Hoopman TC, Wahidi MM, Mahmood K, Cheng GZ, Katsis JM, Kurman JS, D'Haese PF, Johnson J, Grogan EL, Walston C, Yarmus L, Silvestri GA, Rickman OB, Rahman NM, Maldonado F. Navigational Bronchoscopy versus Computed Tomography-guided Transthoracic Needle Biopsy for the Diagnosis of Indeterminate Lung Nodules: protocol and rationale for the VERITAS multicenter randomized trial. medRxiv [Preprint]. 2023 Nov 23:2023.11.22.23298915. doi: 10.1101/2023.11.22.23298915.

    PubMed 38045245

Questions about this trial

What is this clinical trial studying?

A study testing CT-Guided Biopsy and Navigation bronchoscopy in people with Lung Nodule, run by Vanderbilt-Ingram Cancer Center at 7 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 14 Jul 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Diagnostic Accuracy (time frame: Up to 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04250194, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Sep 2025.

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