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Original Research: Pulmonary Procedures |

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

Clara Fontaine-Delaruelle, MD; Pierre-Jean Souquet, MD, FCCP; Delphine Gamondes, MD; Eric Pradat, MD; Aurélie De Leusse, MD; Gilbert R. Ferretti, MD, PhD; Sébastien Couraud, MD
Author and Funding Information

From the Service de pneumologie (Drs Fontaine-Delaruelle, Souquet, and Couraud) and Service d’imagerie (Dr De Leusse), Hospices Civils de Lyon Cancer Institute, CH Lyon Sud, Pierre-Bénite; Faculté de médecine Lyon Est (Dr Fontaine-Delaruelle), Université Lyon 1, 69003 Lyon; EMR 3738 Ciblage thérapeutique en oncologie (Drs Souquet and Courand), Faculté de médecine Lyon Sud, Université Lyon 1, 69495, Pierre-Bénite; Service d’imagerie (Dr Gamondes), Hospices Civils de Lyon, CH Louis Pradel, Bron; Pôle IMER (Dr Pradat), CH Lyon Sud 69495, Pierre-Bénite; Clinique universitaire de radiologie et imagerie médicale (Dr Ferretti), Centre hospitalier universitaire Grenoble, 38043 Grenoble; and Université de Grenoble Alpes (Dr Ferretti), 38000 Grenoble, France.

CORRESPONDENCE TO: Sébastien Couraud, MD, Centre Hospitalier Lyon Sud, Service de Pneumologie Aiguë Spécialisée et Cancérologie Thoracique, 165 chemin du grand Revoyet, 69495 Pierre Bénite CEDEX, France; e-mail: sebastien.couraud@chu-lyon.fr


This study was presented at the 18th French Conference in Respiratory Medicine, January 2014, Marseille, France, and the 20th European Congress of Radiology, March 2014, Vienna, Austria.

FUNDING/SUPPORT: English rewording of the manuscript was supported by a grant from the Bibliothèque scientifique de l’Internat de Lyon and les Hospices Civils de Lyon.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(2):472-480. doi:10.1378/chest.14-1907
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BACKGROUND:  Specimens collected by CT scan-guided transthoracic core-needle biopsy (TTNB) are 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 specimens and investigate predictive factors of negative results.

METHODS:  All consecutive TTNBs performed in three centers between 2006 and 2012 were included. The medical charts of patients with nonmalignant TTNB specimens were reviewed and classified as true or false negatives. Binary logistic regression was used for multivariate analysis.

RESULTS:  Overall, findings from 980 TTNB specimens were included. Malignant disease was found in 79% (n = 777) of the cases, nonmalignant 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 89%, 99%, and 90%, respectively. The complication rate was 34% (life-threatening complication in 6%). In multivariate analysis, predictive factors for a false-negative result were radiologist experience (adjusted OR [AOR], 0.996; 95% CI, [0.994-0.998]), occurrence of a complication during the procedure (AOR, 1.958; 95% CI, [1.202-3.187]), and moderate to high maximum standardized uptake value on PET scan (AOR, 7.657; 95% CI, [1.737-33.763]). In 24 cases, a second TTNB was performed at the same target. The complication rate was 33%, and TTNB specimens provided diagnosis in 95% of cases with a 67% NPV.

CONCLUSIONS:  One-half of all “negative” TTNB specimen results were falsely negative for malignant diagnosis. Findings in tissue collected from a second TTNB at the same target provided a final diagnosis in most cases without increasing complication rates.

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