Negative predictive value of transthoracic core needle biopsy: A multicenter study
Menée sur 980 patients présentant des nodules pulmonaires, cette étude multicentrique évalue la valeur prédictive négative d'une biopsie transthoracique à l'aiguille guidée par tomographie numérique, puis analyse les facteurs prédictifs associés
BACKGROUND: CT-guided transthoracic core-needle biopsy (TTNB) is frequently used for the diagnosis of lung nodules, but the clinical value of negative results has not been sufficiently investigated. We sought to determine the negative predictive value (NPV) of TTNB and investigate predictive factors of negative results.
PATIENTS AND METHOD: All consecutive TTNBs performed in three centers between 2006 and 2012 were included. The medical charts of patients with non-malignant TTNB results were reviewed and classified as true or false negatives. Binary logistic regression was used for multivariate analysis.
RESULTS: Overall, 980 TTNB were included. Malignant disease was found in 79% (n=777) of the cases, non-malignant disease in 6% (n=54) and “negative” results in 15% (n=149). For the diagnosis of malignant disease, NPV was 51%. Estimated sensitivity, specificity and accuracy were respectively 89%, 99% and 90%. The complication rate was 34% (life-threatening complication in 6%). In multivariate analysis, predictive factors for a false-negative result were radiologist experience (AOR=0.996; 95% CI [0.994-0.998]), occurrence of a complication during the procedure (AOR=1.958 [1.202-3.187]), and moderate to high SUVmax on the PET scan (AOR=7.657 [1.737-33.763]). In 24 cases, a second TTNB was performed at the same target. The complication rate was 33% and TTNB provided diagnosis in 95% of cases with a 67% NPV.
CONCLUSION: Half of all “negative” TTNBs are falsely negative for malignant diagnosis. A second TTNB at the same target provides a final diagnosis in most cases without increasing complication rates.
Chest , résumé, 2014