Predictors of False-Negative Results from Percutaneous Transthoracic Fine-Needle Aspiration Biopsy: An Observational Study from a Retrospective Cohort

Abstract

PurposeWe investigated factors predictive of false-negative pulmonary lesions with nonspecific benign cytology results on percutaneous transthoracic fine-needle aspiration biopsy (FNAB).Materials and MethodsWe included 222 pulmonary lesions that had a nonspecific benign result from percutaneous transthoracic FNAB between March 2005 and December 2012, and were confirmed by subsequent pathologic results or adequate clinical follow up over at least 2 years. Clinical, imaging, and biopsy procedure-related findings were compared between lesions with a final diagnosis of malignancy (false-negative) and lesions with a benign diagnosis (true-negative). Multivariate logistic regression analysis was performed to identify significant predictors of false-negatives.ResultsOf 222 lesions, 115 lesions were proved to be false-negatives, and 107 were true-negatives. Compared with the true-negatives, false-negative lesions showed significantly older age (p=0.037), higher maximum standardized uptake value (SUVmax) on positron emission tomography (p=0.001), larger lesion size (p=0.007), and lesion characteristics of a subsolid nodule (p=0.007). On multivariate logistic regression analysis, SUVmax, lesion size, and lesion characteristics were significant predictors of false-negative results.ConclusionAmong the clinical, radiologic, and procedure-related factors analyzed, high SUVmax, large lesion size, and subsolid lesions were useful for predicting malignancy in pulmonary lesions with nonspecific benign cytology results on FNAB.

CT Slice Thickness and Convolution Kernel Affect Performance of a Radiomic Model for Predicting EGFR Status in Non-Small Cell Lung Cancer: A Preliminary Study

“…The outcome of TNM staging is defined by quantitative imaging metrics such as tumor size 41–43 or binary metrics derived from medical images (such as the involvement of the main bronchus or the presence of atelectasis, pneumonitis, or a diaphragm invasion) 44–46 . Furthermore, guiding personalized treatment by imaging biomarkers offers the prospect of a “virtual biopsy”, which is attractive because conventional biopsies are limited to the sampling site and have a low negative predictive value (68%) and a significant false negative rate (9%) 47 , especially in the case of a large lesion and a sub-solid nodule 48 . Additionally, CT-guided lung biopsies are associated with complications such as pneumothorax and parenchymal hemorrhage 49,50 .…”

Pulmonary carcinomas arising in association with scar: Cytomorphologic features in histologically confirmed cases

“…FNA of lung lesions is generally regarded as a safe, accurate, and sensitive method of obtaining a diagnosis with a low‐false‐negative rate 1,24 . However, several factors have been described as contributing to increased false‐negative findings that include larger tumor size, older age, higher uptake on positron emission tomography scan and poor documentation of the needle in the lesion 24‐26 . In non‐pulmonary organ systems, it is known that the presence of fibrosis often leads to a decreased tumor cell yield during FNA.…”

“…1,24 However, several factors have been described as contributing to increased false-negative findings that include larger tumor size, older age, higher uptake on positron emission tomography scan and poor documentation of the needle in the lesion. [24][25][26] In nonpulmonary organ systems, it is known that the presence of fibrosis often leads to a decreased tumor cell yield during FNA. We wanted to investigate if this holds true for LSC, which if true could possibly contribute to a false-negative diagnosis.…”

[18F]FDG PET/CT in the staging of inflammatory breast cancer: A systematic review

“…Finally, in the analysed studies, not every distant metastatic site detected by [ 18 F]FDG PET/CT was confirmed by histopathological analysis. Diagnostic biopsy of the metastatic site is the gold standard for diagnosing metastatic lesions, but also contains the risk of a false negative biopsy and in daily practice histologic evidence of metastatic disease is not always used in treatment decisions in case of a high radiological suspicion (Suh et al, 2016;Monfardini et al, 2014).…”