Non-diagnostic Results of Percutaneous Transthoracic Needle Biopsy: A Meta-analysis

Abstract

Non-diagnostic results can affect the diagnostic performance of percutaneous transthoracic needle biopsy (PTNB) but have not been critically meta-analyzed yet. To meta-analyze the incidence and malignancy rate of non-diagnostic results, 3-by-2 table approaches rather than the conventional 2-by-2 approaches are needed to know its impact on the diagnostic performance of PTNB. A systematic literature search identified studies evaluating the diagnostic performance of PTNB with extractable outcomes. A total of 143 studies with 35,059 biopsies were included. The pooled incidence of non-diagnostic results was 6.8% (95% CI, 6.0–7.6%; I 2 = 0.91). The pooled malignancy rate of non-diagnostic results was 59.3% (95% CI, 51.7–66.8%; I 2 = 0.80), and was correlated with the prevalence of malignancy (correlation coefficient, 0.66; 95% CI, 0.42–0.91). Pooled percentage decrease of sensitivity and specificity due to non-diagnostic results were 4.5% (95% CI, 3.2–5.7%; I 2 = 0.64) and 10.7% (95% CI, 7.7–13.7%; I 2 = 0.70), respectively, and the pooled incidence of non-diagnostic results was 4.4% (95% CI, 3.2–5.8%; I 2 = 0.83) in lesions ultimately diagnosed as malignancies and 10.4% (95% CI, 7.5–13.8%; I 2 = 0.74) in benign disease. In conclusion, non-diagnostic results averagely occurred in 6.8% of PTNB and more than half of the results were malignancies. The non-diagnostic results decreased specificity and sensitivity by 10.7% and 4.5%, respectively, demanding efforts to minimize the non-diagnostic results in PTNB.

2020 Clinical Practice Guideline for Percutaneous Transthoracic Needle Biopsy of Pulmonary Lesions: A Consensus Statement and Recommendations of the Korean Society of Thoracic Radiology

“…Persistent subsolid lesions represent a spectrum of disease from atypical adenomatous hyperplasia to invasive lung adenocarcinoma ( 22 ). When the PTNB result indicated a preinvasive atypical adenomatous hyperplasia, approximately 90% of the lesions were found to be adenocarcinoma upon resection ( 23 ). Furthermore, the diagnostic accuracy of pre-surgical PTNB followed by resection was comparable to that of surgical resection based on CT analysis without PTNB ( 24 ).…”

“…According to a previous meta-analysis ( 23 ), three-fourths of PTNB procedures provide diagnostic results, while one-fourth of procedures are non-diagnostic ( 23 ). When diagnostic, the PTNB result tended to be consistent with the final diagnosis: malignancy rate when PTNB result was malignancy, 99.8%; malignancy rate when PTNBs result was specific benignity, 1.5%.…”

“…However, the malignancy rates of non-diagnostic biopsy results significantly differ according to the category of the non-diagnostic biopsy result ( 55 ). On average, the malignancy rates of non-specific benign results, atypical cells, and insufficient specimens were 20.6%, 91.1%, and 59.2%, respectively ( 23 ). In line with these findings, the 2013 ACCP and 2015 BTS guidelines emphasized that non-diagnostic biopsy results do not rule out the possibility of malignancy ( 12 15 56 ).…”

“…Several guidelines have provided a summary of the diagnostic accuracy of PTNB ( 13 18 19 25 ), and a recent meta-analysis provided an up-to-date summary ( 23 ). In the meta-analysis, the pooled sensitivity and specificity of PTNB procedures reached 97% and 100%, respectively, when omitting PTNB procedures with an insufficient specimen ( Supplementary Fig.…”

“…In the meta-analysis, the pooled sensitivity and specificity of PTNB procedures reached 97% and 100%, respectively, when omitting PTNB procedures with an insufficient specimen ( Supplementary Fig. 2 ) ( 23 ). However, when an insufficient specimen was considered a diagnostic failure, the pooled sensitivity and specificity of PTNB procedures were around 90% ( 23 ).…”