Negative Predictive Value of Transthoracic Core-Needle Biopsy: A Multicenter Study

Area of Science:

• Pulmonology
• Radiology
• Oncology

Background:

• CT scan-guided transthoracic core-needle biopsy (TTNB) is crucial for lung nodule diagnosis.
• The clinical significance of negative TTNB results requires further investigation.

Purpose of the Study:

• To determine the negative predictive value (NPV) of TTNB specimens for malignant lung nodules.
• To identify factors predicting false-negative TTNB results.

Main Methods:

• Retrospective review of 980 TTNB procedures across three centers (2006-2012).
• Classification of nonmalignant specimens as true or false negatives.
• Multivariate analysis using binary logistic regression to identify predictive factors for false negatives.

Main Results:

• The overall NPV for malignant disease was 51%.
• Predictive factors for false negatives included lower radiologist experience, procedure complications, and high PET standardized uptake values.
• A second TTNB at the same target yielded a diagnosis in 95% of cases with a 67% NPV and similar complication rates.

Conclusions:

• Approximately 50% of negative TTNB results may be false negatives for malignancy.
• Repeat TTNB at the same site is effective for achieving a diagnosis without increasing complications.