J Korean Soc Radiol.  2018 Sep;79(3):129-138. 10.3348/jksr.2018.79.3.129.

Study of the Efficacy of PET/CT in Lung Aspiration Biopsy and Factors Associated with False-Negative Results

• Son IW
• Lee JW
• Jeong YJ
• Kim A
• Suh HB
• Lee G

• KMID: 2418654
• DOI: http://doi.org/10.3348/jksr.2018.79.3.129

Abstract

PURPOSE
We compared the outcomes of percutaneous transthoracic needle aspiration biopsy (PCNA) of lung masses in cases with and without prior positron emission tomography/computed tomography (PET/CT) information, and investigated the factors associated with false-negative pathological results.
MATERIALS AND METHODS
From a total of 291 patients, 161 underwent PCNA without prior PET/CT imaging, while 130 underwent PET/CT before PCNA. Clinical characteristics, procedural variables, pathological results, and diagnostic success rates were compared between the 2 groups. Among patients with initial negative (non-specific benign) PCNA results, the radiological findings of these groups were compared to evaluate the predictors of false-negative lesions.
RESULTS
No significant difference was found in the clinical characteristics, procedural characteristics, and pathological results of the 2 groups, nor was the diagnostic rate significantly different between them (p = 0.818). Among patients with initial negative PCNA results, radiological characteristics were similar in both the groups. In multivariate analysis, the presence of necrosis (p = 0.005) and ground-glass opacity (GGO) (p = 0.011) were the significant characteristics that indicated an increased probability of initial false-negative results in PCNA.
CONCLUSION
Routine PET/CT did not have any additional benefit in patients undergoing PCNA of lung masses. The presence of necrosis or GGO could indicate an increased probability of false-negative pathological results.

MeSH Terms

Biopsy, Needle*
Electrons
Humans
Lung Neoplasms
Lung*
Multidetector Computed Tomography
Multivariate Analysis
Necrosis
Needles
Positron-Emission Tomography and Computed Tomography*
Proliferating Cell Nuclear Antigen
Proliferating Cell Nuclear Antigen

Figure

• 

  Fig. 1 A 62-year-old male with a mass located at the right upper lobe posterior segment. PET/CT scan shows homogeneous uptake (SUVmax of 14.3), with no definite additional benefit before percutaneous transthoracic needle aspiration biopsy. Pathologic results revealed squamous cell carcinoma.

• 

  Fig. 2 A 61-year-old female with a heterogeneous, lobulated mass with suspicious necrosis, located at the left upper lobe. PET/CT scan demonstrates high metabolic uptake at the peripheral area of the lesion (SUVmax of 16.7). Thus, the biopsy needle tip is placed at the lesion with highest metabolic uptake. Pathologic results revealed pulmonary tuberculosis. Low-dose chest CT scan (right lower quadrant) after 6 months of anti-tuberculous treatment shows interval decrease of the lesion.

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