title: An investigation into false-negative transthoracic fine needle aspiration and core biopsy specimens.
abstract: Transthoracic fine needle aspiration (TFNA)/core needle biopsy (CNB) under computed tomography (CT) guidance has proved useful in the assessment of pulmonary nodules. We sought to determine the TFNA false-negative (FN) rate at our institution and identify potential causes of FN diagnoses. Medical records were reviewed from 1,043 consecutive patients who underwent CT-guided TFNA with or without CNB of lung nodules over a 5-year time period (2003-2007). Thirty-seven FN cases of "negative" TFNA/CNB with malignant outcome were identified with 36 cases available for review, of which 35 had a corresponding CNB. Cases were reviewed independently (blinded to original diagnosis) by three pathologists with 15 age- and sex-matched positive and negative controls. Diagnosis (i.e., nondiagnostic, negative or positive for malignancy, atypical or suspicious) and qualitative assessments were recorded. Consensus diagnosis was suspicious or positive in 10 (28%) of 36 TFNA cases and suspicious in 1 (3%) of 35 CNB cases, indicating potential interpretive errors. Of the 11 interpretive errors (including both suspicious and positive cases), 8 were adenocarcinomas, 1 squamous cell carcinoma, 1 metastatic renal cell carcinoma, and 1 lymphoma. The remaining 25 FN cases (69.4%) were considered sampling errors and consisted of 7 adenocarcinomas, 3 nonsmall cell carcinomas, 3 lymphomas, 2 squamous cell carcinomas, and 2 renal cell carcinomas. Interpretive and sampling error cases were more likely to abut the pleura, while histopathologically, they tended to be necrotic and air-dried. The overall FN rate in this patient cohort is 3.5% (1.1% interpretive and 2.4% sampling errors).
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Minot
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Gilman
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Aubry
authors.forename: Jesse S
authors.initials: JS
authors.lastname: Voss
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Van Epps
authors.forename: Delores J
authors.initials: DJ
authors.lastname: Tuve
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Sciallis
authors.forename: Michael R
authors.initials: MR
authors.lastname: Henry
authors.forename: Diva R
authors.initials: DR
authors.lastname: Salomao
authors.forename: Peter
authors.initials: P
authors.lastname: Lee
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Carlson
authors.forename: Amy C
authors.initials: AC
authors.lastname: Clayton
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D062005:Biopsy, Large-Core Needle; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000473:pathology*; D016606:Thyroid Nodule / Q000473:pathology*
keywords: computed tomography; cytopathology; diagnosis; lung; neoplasm