Predictors of False-Negative Results from Percutaneous Transthoracic Fine-Needle Aspiration Biopsy: An Observational Study from a Retrospective Cohort

Abstract

Purpose: We investigated factors predictive of false-negative pulmonary lesions with nonspecific benign cytology results on percutaneous transthoracic fine-needle aspiration biopsy (FNAB).

Materials and methods: We included 222 pulmonary lesions that had a nonspecific benign result from percutaneous transthoracic FNAB between March 2005 and December 2012, and were confirmed by subsequent pathologic results or adequate clinical follow up over at least 2 years. Clinical, imaging, and biopsy procedure-related findings were compared between lesions with a final diagnosis of malignancy (false-negative) and lesions with a benign diagnosis (true-negative). Multivariate logistic regression analysis was performed to identify significant predictors of false-negatives.

Results: Of 222 lesions, 115 lesions were proved to be false-negatives, and 107 were true-negatives. Compared with the true-negatives, false-negative lesions showed significantly older age (p=0.037), higher maximum standardized uptake value (SUVmax) on positron emission tomography (p=0.001), larger lesion size (p=0.007), and lesion characteristics of a subsolid nodule (p=0.007). On multivariate logistic regression analysis, SUVmax, lesion size, and lesion characteristics were significant predictors of false-negative results.

Conclusion: Among the clinical, radiologic, and procedure-related factors analyzed, high SUVmax, large lesion size, and subsolid lesions were useful for predicting malignancy in pulmonary lesions with nonspecific benign cytology results on FNAB.

Keywords: Fine needle aspiration; lung cancer; positron-emission tomography.

Fig. 1. Flow diagram of this study. FNAB, fine-needle aspiration biopsy.

Fig. 2. CT and PET images of a false-negative case of a 45-year-old female. (A) CT image prior to FNAB shows a 2.4 cm subsolid nodule in the right lower lobe (arrow). (B) CT image obtained during FNAB shows the needle targeting the subsolid lesion. FNAB cytology result was negative for malignancy. (C) On PET image performed 16 days before FNAB, no increased FDG uptake is seen with the SUVmax measured to be 1.3. Final diagnosis after surgical resection was invasive adenocarcinoma. CT, computed tomography; PET, positron emission tomography; FNAB, fine-needle aspiration biopsy; FDG, fluorodeoxyglucose; SUVmax, maximum standardized uptake value.

Fig. 3. CT and PET images of a false-negative case of a 64-year-old female. (A) CT image prior to FNAB shows a 3.7 cm solid mass in the left upper lobe. (B) CT image obtained during FNAB shows the needle targeting the solid nodule. FNAB cytology result was negative for malignancy. (C) On PET image performed 1 day after FNAB, increased FDG uptake is seen with the SUVmax measured to be 30.5. Final diagnosis after surgical resection was invasive adenocarcinoma. CT, computed tomography; PET, positron emission tomography; FNAB, fine-needle aspiration biopsy; FDG, fluorodeoxyglucose; SUVmax, maximum standardized uptake value.