title: Non-specific benign pathological results on transthoracic core-needle biopsy: how to differentiate false-negatives?
abstract: OBJECTIVE
  To determine the negative predictive value (NPV) of non-specific benign results from cone-beam CT (CBCT)-guided transthoracic core-needle biopsy (TTNB) and identify predicting factors for false-negative for malignancies.
  
  
  METHODS
  From January 2009-December 2011, 1,108 consecutive patients with 1,116 lung lesions underwent CBCT-guided TTNB using an 18-gauge coaxial cutting needle. Among them, 226 patients with 226 TTNBs, initially diagnosed as non-specific benign, were included in this study. The medical charts, radiological or pathological follow-ups were reviewed to classify false-negative and true-negative results and to identify which variables were associated with false-negatives.
  
  
  RESULTS
  Of 226 lesions, 24 (10.6%) were finally confirmed as malignancies and 202 (89.4%) as benign, of which the NPV was 89.4% (202/226). Multivariate analysis revealed that part-solid nodule (PSN) (odds ratio (OR), 3.95; P = 0.022), a biopsy result of 'granulomatous inflammation' (OR, 0.04; P = 0.022), and exact location of needle tip within targets (OR, 0.37; P = 0.045) were significantly associated with false-negatives among initial non-specific benign biopsy results.
  
  
  CONCLUSIONS
  The NPV of the non-specific benign biopsy was 89.4%. PSN was a significant positive indicator, but a biopsy result of 'granulomatous inflammation' and exact location of needle tip within targets were significant negative indicators for false-negatives.
  
  
  CONCLUSIONS
  • The negative predictive value of the non-specific benign biopsy was 89.4%. • A part-solid nodule is a significant predictor for false-negative biopsy (OR = 3.95). • Pathological diagnosis of granulomatous inflammation is a robust indicator for 'true-negatives'. • Identifying needle tip within target lesions is a significant predictor for 'true-negatives'.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea.|Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
authors.forename: Jung Im
authors.initials: JI
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea. cmpark.morphius@gmail.com.|Cancer Research Institute, Seoul National University, Seoul, Korea. cmpark.morphius@gmail.com.
authors.forename: Chang Min
authors.initials: CM
authors.lastname: Park
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Hyungjin
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Jong Hyuk
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea.|Cancer Research Institute, Seoul National University, Seoul, Korea.
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Goo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000379:methods; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005188:False Negative Reactions; D005260:Female; D006099:Granuloma / Q000473:pathology; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009339:Needles; D011014:Pneumonia / Q000473:pathology; D011871:Radiology; D012189:Retrospective Studies
keywords: Biopsy; Granuloma; Large-core needle; Lung; Negative predictive value