title: Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules.
abstract: OBJECTIVE
  The aim of this study was to analyse factors predicting the diagnostic accuracy of computed tomography (CT)-guided transthoracic fine-needle aspiration (TTFNA) for solid noncalcified, subsolid and mixed pulmonary nodules, with particular attention to those responsible for false negative results with a view to suggesting a method for their correction.
  
  
  METHODS
  From January 2007 to March 2010, we retrospectively reviewed the CT images of 198 patients of both sexes (124 males and 74 females; mean age, 70 years; range age, 44-90) used for the guidance of TTFNA of pulmonary nodules. Aspects considered were: lesion size and density, distance from the pleura, and lesion site. Multiplanar reformatted images (MPR) were retrospectively obtained in the sagittal and axial oblique planes relative to needle orientation.
  
  
  RESULTS
  The overall diagnostic accuracy of TTFNA CT-guided biopsy was 86% for nodules between 0.7 and 3 cm, 83.3% for those between 0.7 and 1.5 cm, and 92% for those between 2 and 3 cm. Accuracy was 95.1% for solid pulmonary nodules, 84.6% for mixed nodules, and 66.6% for subsolid nodules. The diagnostic accuracy of CT-guided TTFNA in relation to the distance between the nodule and the pleural plane was 95.6% for lesions adhering to the pleura and 83.5% for central ones. The diagnostic accuracy was 84.2% for the pulmonary upper lobe nodules, 85.3% for the lower lobe and 90.9% for those in the lingula and middle lobe. In 75% of false negative and inadequate/insufficient cases the needle was found to lie outside the lesion, after reconstruction of the needle path by MPR.
  
  
  CONCLUSIONS
  The positive predictive factors of CT-guided TTFNA are related to the nodule size, density and distance from the pleural plane. The most common negative predictive factor of CT-guided TTFNA is the wrong position of the needle tip, as observed in the sagittal and axial oblique sections of the MPR reconstructions. The diagnostic accuracy of CT-guided TTFNA can therefore be improved by using the MPR technique to plan the needle path during the FNA procedure.
authors.affiliation: Radiology Unit, University of Parma, Parma Hospital, Via Gramsci 14, 43100, Parma, Italy, massimo.defilippo@unipr.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: De Filippo
authors.forename: Luca
authors.initials: L
authors.lastname: Saba
authors.forename: Giorgio
authors.initials: G
authors.lastname: Concari
authors.forename: Rita
authors.initials: R
authors.lastname: Nizzoli
authors.forename: Lilia
authors.initials: L
authors.lastname: Ferrari
authors.forename: Marcello
authors.initials: M
authors.lastname: Tiseo
authors.forename: Andrea
authors.initials: A
authors.lastname: Ardizzoni
authors.forename: Nicola
authors.initials: N
authors.lastname: Sverzellati
authors.forename: Ilaria
authors.initials: I
authors.lastname: Paladini
authors.forename: Chiara
authors.initials: C
authors.lastname: Ganazzoli
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Carrafiello
authors.forename: Luca
authors.initials: L
authors.lastname: Brunese
authors.forename: Eugenio Annibale
authors.initials: EA
authors.lastname: Genovese
authors.forename: Luca
authors.initials: L
authors.lastname: Ampollini
authors.forename: Paolo
authors.initials: P
authors.lastname: Carbognani
authors.forename: Michele
authors.initials: M
authors.lastname: Rusca
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zompatori
authors.forename: Cristina
authors.initials: C
authors.lastname: Rossi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed