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

Abstract

Background: Computed tomography (CT)-guided cutting needle biopsy (CNB) has been widely used for the diagnosis of lung nodules (LNs). The false-negative rate of CT-guided lung biopsy is reported to be up to 16%. The aim of this study was to determine the predictors of true-negative results in LNs with CNB-based benign results. Methods: From January 2011 to December 2015, 96 patients with CNB-based non-specific benign results were included in this study as the training group to detect predictors of true-negative results. From January 2016 to December 2018, an additional 57 patients were included as a validation group to test the reliability of the predictors. Results: In the training group, a total of 96 patients underwent CT-guided CNB for 96 LNs. The CNB-based results were true-negatives for 82 LNs and false-negatives for 14 LNs. The negative predictive value of the CNB-based benign results was 85.4% (82/96). Univariate and multivariate logistic regression analyses revealed that CNB-based chronic inflammation with fibroplasias (P = 0.013, hazard ratio = 0.110, 95% confidential interval = 0.019–0.625) was the independent predictor of true-negative results. The area under the receiver operator characteristic (ROC) curve was 0.697 (P = 0.019). In the validation group, biopsy results for 47 patients were true-negative and 10 were false-negative. When the predictor was used on the validation group, the area under the ROC curve was 0.759 (P = 0.011). Conclusions: Most of the CNB-based benign results were true-negatives, and CNB-based chronic inflammation with fibroplasias could be considered a predictor of true-negative results.