title: Negative Predictive Value of Transthoracic Core-Needle Biopsy: A Multicenter Study.
abstract: 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.
authors.affiliation: From the Service de pneumologie, 38000 Grenoble, France; Hospices Civils de Lyon Cancer Institute, CH Lyon Sud, Pierre-Bénite; Faculté de médecine Lyon Est, 38000 Grenoble, France.
authors.forename: Clara
authors.initials: C
authors.lastname: Fontaine-Delaruelle
authors.affiliation: From the Service de pneumologie, 38000 Grenoble, France; Université Lyon 1, 69003 Lyon; EMR 3738 Ciblage thérapeutique en oncologie, 38000 Grenoble, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Souquet
authors.affiliation: Faculté de médecine Lyon Sud, Université Lyon 1, 69495, Pierre-Bénite; Service d'imagerie, 38000 Grenoble, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Gamondes
authors.affiliation: Hospices Civils de Lyon, CH Louis Pradel, Bron; Pôle IMER, 38000 Grenoble, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Pradat
authors.affiliation: Service d'imagerie, 38000 Grenoble, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: De Leusse
authors.affiliation: CH Lyon Sud 69495, Pierre-Bénite; Clinique universitaire de radiologie et imagerie médicale, 38000 Grenoble, France; Centre hospitalier universitaire Grenoble, 38043 Grenoble; and Université de Grenoble Alpes, 38000 Grenoble, France.
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Ferretti
authors.affiliation: From the Service de pneumologie, 38000 Grenoble, France; Université Lyon 1, 69003 Lyon; EMR 3738 Ciblage thérapeutique en oncologie, 38000 Grenoble, France. Electronic address: sebastien.couraud@chu-lyon.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Couraud
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle; D015331:Cohort Studies; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed