Computed tomography-guided biopsy of small lung nodules: diagnostic accuracy and analysis for true negatives

Abstract

Objective We evaluated the diagnostic accuracy of computed tomography (CT)-guided transthoracic core needle biopsy (TCNB) for small (≤20-mm) lung nodules and identified predictive factors for true negatives among benign biopsy results. Methods From March 2010 to June 2015, 222 patients with small lung nodules underwent CT-guided TCNB. We retrospectively analysed data regarding technical success, diagnostic accuracy, and predictors of true negatives. Results The technical success rate was 100%. The TCNB results of the 222 lung nodules included malignancy (n = 136), suspected malignancy (n = 8), specific benign lesion (n = 17), and nonspecific benign lesion (n = 61). The final diagnosis of 222 lung nodules included malignant (n = 160), benign (n = 60), and nondiagnostic lesions (n = 2). The sensitivity, specificity, and overall diagnostic accuracy of CT-guided TCNB for small lung nodules were 90.0%, 100%, and 92.7%, respectively. Pneumothorax and haemoptysis occurred in 23 and 41 patients, respectively. Based on the Cox regression analysis, the significant independent predictive factor for true negatives was a biopsy result of chronic inflammation with fibroplasia. Conclusions CT-guided TCNB offers high diagnostic accuracy for small lung nodules, and a biopsy result of chronic inflammation with fibroplasia can predict a true-negative result.

Computed tomography-guided cutting needle biopsy for lung nodules: when the biopsy-based benign results are real benign

“…First of all, the NPV in the training group of this study was 85.4%, which is within the range demonstrated by previous studies regarding CT-guided CNB for lung lesions (78−90%) [9,10,12].…”

“…Abnormal tumor marker levels were not found to be associated with false-negative results, although univariate logistic analysis demonstrated that abnormal CEA and SCC levels were predictors of falsenegative results. Also previous studies did not find any tumor marker level to be associated with false-negatives from CNB-based benign results [9,10,12].…”

“…The true-negative group had a significantly higher rate of cases with CNBbased chronic inflammation with fibroplasias than the false-negative group (54.9% vs. 7.1%, respectively; P = 0.001). Similarly, Liu et al [12] also found that CNB-based chronic inflammation with fibroplasias is a predictor of true-negative results. Chronic inflammation with fibroplasias is considered a first step to the formation of organizing pneumonia or granulomatous inflammation [12,14,15].…”

“…Similarly, Liu et al [12] also found that CNB-based chronic inflammation with fibroplasias is a predictor of true-negative results. Chronic inflammation with fibroplasias is considered a first step to the formation of organizing pneumonia or granulomatous inflammation [12,14,15]. Therefore, it is reasonable that CNB-based chronic inflammation with fibroplasias may indicate a true-negative result.…”

Endobronchial ultrasound‐guided versus computed tomography‐guided biopsy for peripheral pulmonary lesions: A meta‐analysis

“…CT‐TTNB was commonly associated with complications including pneumothorax and hemorrhage. Risk factors associated with CT‐TTNB adverse outcomes include a longer distance to the pleura, the number of needle pathways used, and the position of the patient during biopsy 29,30 . In contrast, the EBUS approach is conducted in the bronchial lumen, thereby avoiding damage to the lung parenchyma.…”