Korean J Radiol.  2019 Aug;20(8):1300-1310. 10.3348/kjr.2019.0189.

Diagnostic Accuracy of Percutaneous Transthoracic Needle Lung Biopsies: A Multicenter Study

• Lee KH
• Lim KY
• Suh YJ
• Hur J
• Han DH
• Kang MJ
• Choo JY
• Kim C
• Kim JI
• Yoon SH
• Lee W
• Park CM

• KMID: 2453080
• DOI: http://doi.org/10.3348/kjr.2019.0189

Abstract

OBJECTIVE
To measure the diagnostic accuracy of percutaneous transthoracic needle lung biopsies (PTNBs) on the basis of the intention-to-diagnose principle and identify risk factors for diagnostic failure of PTNBs in a multi-institutional setting.
MATERIALS AND METHODS
A total of 9384 initial PTNBs performed in 9239 patients (mean patient age, 65 years [range, 20-99 years]) from January 2010 to December 2014 were included. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PTNBs for diagnosis of malignancy were measured. The proportion of diagnostic failures was measured, and their risk factors were identified.
RESULTS
The overall accuracy, sensitivity, specificity, PPV, and NPV were 91.1% (95% confidence interval [CI], 90.6-91.7%), 92.5% (95% CI, 91.9-93.1%), 86.5% (95% CI, 85.0-87.9%), 99.2% (95% CI, 99.0-99.4%), and 84.3% (95% CI, 82.7-85.8%), respectively. The proportion of diagnostic failures was 8.9% (831 of 9384; 95% CI, 8.3-9.4%). The independent risk factors for diagnostic failures were lesions ≤ 1 cm in size (adjusted odds ratio [AOR], 1.86; 95% CI, 1.23-2.81), lesion size 1.1-2 cm (1.75; 1.45-2.11), subsolid lesions (1.81; 1.32-2.49), use of fine needle aspiration only (2.43; 1.80-3.28), final diagnosis of benign lesions (2.18; 1.84-2.58), and final diagnosis of lymphomas (10.66; 6.21-18.30). Use of cone-beam CT (AOR, 0.31; 95% CI, 0.13-0.75) and conventional CT-guidance (0.55; 0.32-0.94) reduced diagnostic failures.
CONCLUSION
The accuracy of PTNB for diagnosis of malignancy was fairly high in our large-scale multi-institutional cohort. The identified risk factors for diagnostic failure may help reduce diagnostic failure and interpret the biopsy results.

Keyword

Image-guided biopsy; Sensitivity and specificity; Lung neoplasms; Multicenter study

MeSH Terms

Biopsy*
Biopsy, Fine-Needle
Cohort Studies
Cone-Beam Computed Tomography
Diagnosis
Humans
Image-Guided Biopsy
Lung Neoplasms
Lung*
Lymphoma
Needles*
Odds Ratio
Risk Factors
Sensitivity and Specificity

Figure

• 

  Fig. 1 Axial CT images in 78-year-old man with history of esophageal cancer.A. Contrast-enhanced chest CT image shows 1.3-cm solid nodule in right upper lobe (arrow). B. CT-guided PTNB was performed by using 22-gauge aspiration needle, and pathologic examination showed adenocarcinoma of pulmonary origin (true-positive result). Patient underwent right upper lobectomy, and lesion was confirmed to be adenocarcinoma in pathologic examination. PTNB = percutaneous transthoracic needle lung biopsy

• 

  Fig. 2 Axial CT images in 21-year-old man diagnosed with acquired immunodeficiency syndrome.He was referred for incidentally detected pulmonary mass during treatment of Pneumocystis jiroveci pneumonia.A. Contrast-enhanced chest CT image shows 4.0-cm mildly enhanced mass in left lower lobe (arrow). B. CT-guided PTNB was performed by using 22-gauge aspiration needle, and pathologic examination showed chronic inflammation (false-negative result). Patient underwent left lower lobectomy, and lesion was confirmed to be malignant lymphoma in pathologic examination.

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