Jung Im Kim MD, Presenter: Nothing to Disclose

Chang Min Park MD, PhD, Abstract Co-Author: Nothing to Disclose

Sang Min Lee, Abstract Co-Author: Nothing to Disclose

Kwang Gi Kim PhD, Abstract Co-Author: Nothing to Disclose

Jin Mo Goo MD, PhD, Abstract Co-Author: Research Grant, Guerbet SA

To identify the distinguishing features of malignancies falsely-diagnosed as non-specific benign lesions in pathologic examinations obtained from percutaneous transthoracic needle biopsy(PTNB) from true benign lesions.    

From January 2009 to December 2011, 1108 consecutive patients (633 males and 475 females; mean age, 62.4 years) with 1116 lung lesions (mean size, 2.7cm ± 1.7) underwent C-Arm Cone-Beam CT (CBCT)-guided PTNB using an 18-gauge coaxial cutting needle. Among them, 285 lesions (mean size, 2.4 cm ± 1.4) in 283 patients (154 males and 129 females; mean age, 59.2 years) were diagnosed as non-specific benign lesions at pathologic evaluation. The malignancy rate of these non-specific benign pathologies was investigated. To evaluate the discriminating clinical, radiological and pathological findings of these malignancies falsely-diagnosed as non-specific benign lesions from true benign lesions, univariate and multivariate logistic regression analyses were performed.

Among 285 lesions, 24 (8.4%) were finally diagnosed as malignant, 202 (70.9%) as benign and 59 (20.7%) as indeterminate. The negative predictive value (NPV) of the non-specific benign lesions was 89.4% (202/226). For 81 lesions in which the pathologic results were granulomatous inflammation and 141 lesions with negative CT reports for lung cancer, NPVs were 100% and 99.3%, respectively. Multivariate analysis revealed that positive CT reports for lung cancer (odds ratio (OR), 29.7; P<0.001) and granulomatous inflammations on PTNB (OR, 0.03; P=0.018) were significant discriminating factors of these malignancies falsely-diagnosed as benign lesions from true benignancies with excellent differentiating accuracy (area under the ROC curve, 0.944). 

Among pulmonary lesions showing non-specific benign pathologies on PTNB, positive CT reports for lung cancer and pathologic results of granulomatous inflammations on PTNB were significant discriminating factors for malignancies falsely-diagnosed as non-specific benign lesions.

Among non-specific benign biopsies, false negative and true negative lesions can be accurately discriminated through evaluation of diagnostic CT and pathologic reports of PTNB.

Kim, J, Park, C, Lee, S, Kim, K, Goo, J, How to Discriminate Malignancies Falsely-diagnosed as Non-specific Benign Lesions after Percutaneous Transthoracic Needle Biopsy from True Benign Lesions.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017565.html