Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT.
AJR Am J Roentgenol. 2020 Jul;215(1):116-120. doi: 10.2214/AJR.19.22244. Epub 2020 Mar 11.
For nondiagnostic CT-guided lung biopsies, we tested whether radiologicpathologic correlation could identify patients who may benefit from repeat biopsy. In this retrospective study, 1525 lung biopsies were performed between July 2013 and June 2017, 243 of which were nondiagnostic. Of these 243 lung biopsies, 98 were performed to evaluate for lung malignancy; 17 were excluded because of insufficient follow-up, leaving a total of 81 cases. The Brock and Herder models were used to calculate risk; in addition, cases were independently blindly reviewed by two thoracic radiologists who assigned a score from 1 (probably benign) to 5 (probably malignant). The final diagnosis was established by pathology results or benignancy was established if the lesion resolved or remained stable for at least 2 years. Of the 81 nondiagnostic lung biopsies, initial pathology results included 33 cases of inflammation, 28 cases of normal lung tissue or insufficient sample, 10 cases of organizing pneumonia, and 10 cases of atypical cells. 42% (34/81) of cases were eventually determined to be malignant (negative predictive value [NPV] of 58%). Pathology results of organizing pneumonia had the lowest rate of malignancy (2/10 = 20%), and pathology results of atypical cells had the highest rate of malignancy (5/10 = 50%, = 0.51). Within this highly selected cohort, the Brock and Herder models were not predictive of malignancy, with areas under the ROC curve (AUCs) of 0.52 and 0.52, respectively. Evaluation by thoracic radiologists yielded AUCs of 0.85 and 0.77. When radiologist-assigned scores of 1 and 2 were considered as benign, the NPV was 90% and 95%. Review of nondiagnostic lung biopsies for radiologic-pathologic concordance by thoracic radiologists can triage patients who may benefit from repeat biopsy.
对于非诊断性 CT 引导下的肺活检，我们测试了影像学-病理学相关性是否可以识别可能从重复活检中获益的患者。在这项回顾性研究中，我们在 2013 年 7 月至 2017 年 6 月期间进行了 1525 例肺活检，其中 243 例为非诊断性。在这 243 例肺活检中，98 例用于评估肺癌；17 例因随访不足而被排除，共 81 例。使用布罗克和赫德模型计算风险；此外，两名胸部放射科医生对 81 例非诊断性肺活检进行了独立盲法复查，每位医生从 1（可能良性）到 5（可能恶性）对其进行评分。最终诊断根据病理结果确定，如果病变至少 2 年消退或保持稳定，则确定为良性。在 81 例非诊断性肺活检中，初始病理结果包括 33 例炎症、28 例正常肺组织或样本不足、10 例机化性肺炎和 10 例非典型细胞。42%（34/81）的病例最终被确定为恶性（阴性预测值[NPV]为 58%）。机化性肺炎的病理结果恶性率最低（2/10=20%），非典型细胞的病理结果恶性率最高（5/10=50%，=0.51）。在这个高度选择的队列中，布罗克和赫德模型均不能预测恶性肿瘤，ROC 曲线下面积（AUC）分别为 0.52 和 0.52。胸部放射科医生的评估得出的 AUC 分别为 0.85 和 0.77。当将放射科医生评分 1 和 2 视为良性时，NPV 为 90%和 95%。胸部放射科医生对非诊断性肺活检进行影像学-病理学一致性复查，可以对可能从重复活检中获益的患者进行分诊。
