Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Radiology, National Cancer Center, Goyang, Korea.
Korean J Radiol. 2019 Aug;20(8):1300-1310. doi: 10.3348/kjr.2019.0189.
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.
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.
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.
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.
基于意向诊断原则，测量经皮经胸肺穿刺活检术（PTNB）的诊断准确性，并确定多机构环境下 PTNB 诊断失败的风险因素。
纳入了 2010 年 1 月至 2014 年 12 月期间 9239 例患者（平均患者年龄 65 岁[范围：20-99 岁]）共 9384 例初始 PTNB。测量 PTNB 对恶性肿瘤的诊断准确性、灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。测量诊断失败的比例，并确定其风险因素。
总体准确性、灵敏度、特异度、PPV 和 NPV 分别为 91.1%（95%置信区间[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%）和 84.3%（95% CI，82.7-85.8%）。诊断失败的比例为 8.9%（831 例/9384 例；95% CI，8.3-9.4%）。诊断失败的独立风险因素为病变直径≤1 cm（调整优势比[AOR]，1.86；95% CI，1.23-2.81）、直径 1.1-2 cm（1.75；1.45-2.11）、亚实性病变（1.81；1.32-2.49）、仅使用细针抽吸（2.43；1.80-3.28）、最终诊断为良性病变（2.18；1.84-2.58）和最终诊断为淋巴瘤（10.66；6.21-18.30）。使用锥形束 CT（AOR，0.31；95% CI，0.13-0.75）和常规 CT 引导（0.55；0.32-0.94）降低了诊断失败的风险。
在我们的大规模多机构队列中，PTNB 对恶性肿瘤的诊断准确性相当高。确定的诊断失败风险因素可能有助于降低诊断失败率并解释活检结果。
