Negative Predictive Value of Transthoracic Core-Needle Biopsy

The British Thoracic Society guidelines on the investigation and management of pulmonary nodules

“…When a biopsy is negative (ie, non-malignant), there is still approximately a 50% chance of malignancy where the pre-test probability is 90%. These calculations were recently confirmed in the largest retrospective series where there was a 90% prevalence of malignancy 9. The authors emphasised the importance of considering repeat biopsies as they also showed that these usually confirmed the diagnosis of malignancy.…”

Nondiagnostic Computed Tomography–guided Percutaneous Lung Biopsies Are More Likely When Infection Is Suspected

“…2,8 Variability in biopsy success has been attributed to technique, including number of passes, 8 the use of core versus fine-needle aspiration sampling, [9][10][11] needle trajectory, 12 and having a pathologist present to evaluate the sample. 13 Other groups have published that nodule characteristics affect the nondiagnostic rate of CTLB, with small size and presence of necrosis leading to lower rates of success.…”

“…13 Other groups have published that nodule characteristics affect the nondiagnostic rate of CTLB, with small size and presence of necrosis leading to lower rates of success. 2,5,8,14 To our knowledge, no studies have investigated the association between the pretest likelihood for cancer versus infection and the nondiagnostic rate. Overall, understanding the nondiagnostic rate on the basis of a set of predictive factors is important to accurately consent patients and to inform referring clinicians who must decide between various diagnostic options to obtain a diagnosis.…”

Management of pulmonary nodules according to the 2015 British Thoracic Society guidelines. Key messages for clinical practice

“…This is considerably less than those for CT-guided percutaneous transthoracic biopsy (pooled 91%), although the latter has a much higher pneumothorax rate (6.6% requiring chest drain in the largest series). [65][66][67][68] The latter may be important for some patients, although ENB and, to a lesser extent, radial EBUS may be very time-consuming and are not as widely available as percutaneous biopsy.…”

“…There was also evidence that repeat biopsies usually achieved a diagnosis when the first was indeterminate. 68 Variables associated with better CT-guided biopsy performance were nodule size, 69 nodule morphology, 70 needle path length, use of C-arm cone beam system, 71 multiplanar reconstruction, 72 and immediate cytological assessment. 73 The BTS guideline provides greater clarity about the utility of biopsy in indeterminate lesions and specifically recommends repeating the procedure when the first is indeterminate.…”