Study of the Efficacy of PET/CT in Lung Aspiration Biopsy and Factors Associated with False-Negative Results

Wan Son; Ji Won Lee; Yeon Joo Jeong; Ahrong Kim; Hie Bum Suh; Geewon Lee

doi:10.3348/jksr.2018.79.3.129

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Son, Lee, Jeong, Kim, Suh, and Lee: Study of the Efficacy of PET/CT in Lung Aspiration Biopsy and Factors Associated with False-Negative Results

Original Article

J Korean Soc Radiol 2018;79(3):129-138.

Published online: 19 January 2018

DOI: https://doi.org/10.3348/jksr.2018.79.3.129

Study of the Efficacy of PET/CT in Lung Aspiration Biopsy and Factors Associated with False-Negative Results

Wan Son, MD¹, Ji Won Lee, MD^1,², Yeon Joo Jeong, MD^1,², Ahrong Kim, MD³, Hie Bum Suh, MD¹, Geewon Lee, MD^1,^2,

¹Departments of Radiology, Pusan National University Hospital, Busan, Korea

²Departments of Medical Research Institute, Pusan National University Hospital, Busan, Korea

³Departments of Pathology, Pusan National University Hospital, Busan, Korea

^∗Corresponding author: Geewon Lee, MD Departments of Radiology, Medical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel. 82-51-240-7354 Fax. 82-51-244-7534 E-mail: rabkingdom@naver.com

Received 1 February 2018 Revised 5 April 2018 Accepted 15 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We compared the outcomes of percutaneous transthoracic needle aspiration biopsy (PCNA) of lung masses in cases with and without prior positron emission tomography/computed tomography (PET/CT) information, and investigated the factors associated with false-negative pathological results.

Materials and Methods

From a total of 291 patients, 161 underwent PCNA without prior PET/CT imaging, while 130 underwent PET/CT before PCNA. Clinical characteristics, procedural variables, pathological results, and diagnostic success rates were compared between the 2 groups. Among patients with initial negative (non-specific benign) PCNA results, the radiological findings of these groups were compared to evaluate the predictors of false-negative lesions.

Results:

No significant difference was found in the clinical characteristics, procedural characteristics, and pathological results of the 2 groups, nor was the diagnostic rate significantly different between them (p = 0.818). Among patients with initial negative PCNA results, radiological characteristics were similar in both the groups. In multivariate analysis, the presence of necrosis (p = 0.005) and ground-glass opacity (GGO) (p = 0.011) were the significant characteristics that indicated an increased probability of initial false-negative results in PCNA.

Conclusion

Routine PET/CT did not have any additional benefit in patients undergoing PCNA of lung masses. The presence of necrosis or GGO could indicate an increased probability of false-negative pathological results.

Keywords: PET-CT, Lung Neoplasms, Multidetector Computed Tomography

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Fig. 1

A 62-year-old male with a mass located at the right upper lobe posterior segment. PET/CT scan shows homogeneous uptake (SUVmax of 14.3), with no definite additional benefit before percutaneous transthoracic needle aspiration biopsy. Pathologic results revealed squamous cell carcinoma.

Fig. 2

A 61-year-old female with a heterogeneous, lobulated mass with suspicious necrosis, located at the left upper lobe. PET/CT scan demonstrates high metabolic uptake at the peripheral area of the lesion (SUVmax of 16.7). Thus, the biopsy needle tip is placed at the lesion with highest metabolic uptake. Pathologic results revealed pulmonary tuberculosis. Low-dose chest CT scan (right lower quadrant) after 6 months of anti-tuberculous treatment shows interval decrease of the lesion.

Table 1.

Clinical Characteristics, Procedure Characteristics, and Pathologic Results of Patients who Underwent Percutaneous Transthoracic Needle Aspiration Biopsy between Those with and without PET Scans

	No PET (n = 161)	PET (n = 130)	p-Value
Clinical characteristics
Age (years) ± SD	64.9 ± 11.5	65.7 ± 9.1	0.506
Sex			0.639
Male	108	87
Female	53	43
Procedure characteristics .
Lesion size (cm) ± SD	4.7 ± 2.6	4.7 ± 2.5	0.973
Lesion location			0.084
Upper	104	71
Lower	57	59
Types of imaging guidance			0.498
CT	89	77
Fluoroscopy	72	53
Position			0.400
Supine	66	47
Prone	95	83
Pathologic results
Adequate diagnosis	141	115	0.818
Benign	18	15
Malignant	123	100
Negative	20	15

CT = computed tomography, PET = positron emission tomography, SD = standard deviation

Table 2.

Comparison of Radiological Characteristics among Patients with Initial Negative Percutaneous Transthoracic Needle Aspiration Biopsy Results

Radiological Characteristics	No PET (n = 20)	PET (n = 15)	p-Value
Presence of atelectasis	2	2	0.999
Presence of necrosis	11	7	0.625
Presence of consolidation adjacent to lesion	6	4	0.999
Presence of pleural effusion	4	3	0.999
Presence of GGO	6	2	0.419

GGO = ground-glass opacity, PET = positron emission tomography

Table 3.

Comparison of Characteristics between False-Negative and True-Negative Lesions

	True Negative (n = 15)	False Negative (n = 20)	p-Value
Clinical characteristics
Age (years) ± SD	62.9 ± 13.0	63.0 ± 10.6	0.973
Sex			0.680
Male	13	16
Female	2	4
Presence of PET			0.076
PET	9	6
No PET	6	14
Radiological characteristics
Presence of atelectasis	1	3	0.443
Presence of necrosis	4	14	0.011∗
Presence of consolidation adjacent to lesion	3	7	0.331
Presence of pleural effusion	2	5	0.393
Presence of GGO	1	7	0.101
Procedure characteristics
Lesion size (cm) ± SD	3.0 ± 1.6	3.9 ± 2.8	0.262
Lesion location			0.324
Upper	10	10
Lower	5	10
Types of imaging guidance			0.163
CT	11	10
Fluoroscopy	4	10
Position			0.693
Supine	7	8
Prone	8	12

∗Significant p-value.

CT = computed tomography, GGO = ground-glass opacity, PET = positron emission tomography, SD = standard deviation

Table 4.

Results of Univariate and Multivariate Logistic Regression Analysis for Predictors of False-Negative Lesions at Percutaneous Transthoracic Needle Aspiration Biopsy

	Univariate			Multivariate
	OR	95% CI	p-Value	OR	95% CI	p-Value
Age (year)	1.001	0.944–1.062	0.972
Sex (male)	0.615	0.097–3.908	0.607
Presence of PET (+)	0.286	0.070–1.168	0.081	0.275	0.040–1.863	0.186
Lesion size (cm)	1.238	0.841–1.821	0.279
Lesion location (lower)	2.000	0.500–7.997	0.327
Types of imaging guidance (CT)	0.364	0.086–1.537	0.169
Position (prone)	1.312	0.339–5.076	0.694
Presence of atelectasis (+)	2.471	0.231–26.459	0.455
Presence of necrosis (+)	6.417	1.444–28.511	0.015	34.514	2.958–402.699	0.005∗
Presence of consolidation (+)	2.154	0.451–10.287	0.336
Presence of pleural effusion (+)	2.167	0.358–13.110	0.400
Presence of GGO (+)	7.538	0.813–69.906	0.075	51.812	2.435–1102.354	0.011∗
OR associated with age and lesion size is that the increase in hazard is associated with a 1-year increase in age and 1-cm increase in size, respectively.
∗Significant p-value.

CI = confidence interval, CT = computed tomography, GGO = ground-glass opacity, OR = odds ratio, PET = positron emission tomography

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