Diagnostic Accuracy of CT Readings of Coin Lesions in the Lung as Compared with Transthoracic CT-Guided Needle Biopsy Results

Abstract

Background: The aim of this study was to compare chest CT film reading results with histopathological results after CT-guided transthoracic needle biopsy of the lung. In addition, lung lesion morphology was evaluated and compared with the nature of the lesions.

Patients and Methods: Pulmonary lesions of 133 patients who underwent chest CT were retrospectively grouped into benign, malignant or uncertain. All patients underwent CT-guided transthoracic biopsy. Results of CT diagnosis and histopathological evaluation were compared. In addition, CT features such as size, borders, shape and presence of necrosis were assessed and compared with histopathological results.

Results: In 129 patients adequate specimens were obtained. Comparison of CT diagnosis with the histopathological results yielded the following results for chest CT: sensitivity 95 %, specificity 43 %, positive predictive value 83 %, and negative predictive value 75 %. Lesions with spiculated margins turned out to be associated with a significantly higher number of malignant lesions than lesions with smooth or blurred margins (p < 0.05). Lesions size, lesion shape as well as the presence of necrosis showed no significant relation to nature of the lesions (p > 0.05).

Conclusion: Radiological assessment of pulmonary lesions alone is not sufficient. the specificity of chest CT is not sufficient to make a definitive diagnosis, i. e., histological verification is still needed for further investigation in a large number of cases. Only lesions with spiculated margins showed a significantly higher number of malignant degenerations in histological evaluation.

Zusammenfassung

Hintergrund: Zum Vergleich CT-morphologischer Befunde fokaler Lungenherde mit histopathologischen Resultaten der CT-gesteuerten Biopsie. Zusätzlich erfolgte die Auswertung bildmorphologischer Kriterien und deren Vergleich mit der histopathologischen Dignität der Läsionen.

Patienten und Methoden: Computertomografisch detektierte Lungenherde von 133 Patienten wurden retrospektiv in benigne, maligne und unklare Läsionen eingeteilt. Alle Läsionen wurden CT-gesteuert punktiert. Die Ergebnisse der CT-morphologischen Bildanalyse sowie der histopathologischen Evaluation wurden verglichen. Zusätzlich wurden bildmorphologische Kriterien wie Größe, Berandung, Form und das Vorliegen von Nekrosen erfasst und mit den histopathologischen Resultaten verglichen.

Ergebnisse: 129 Patienten wurden erfolgreich punktiert. Der Vergleich der computertomografischen Diagnose mit den histopathologischen Resultaten ergab für die CT eine Sensitivität von 95 %, eine Spezifität von 43 %, einen positiven Vorhersagewert von 83 % sowie einen negativen Vorhersagewert von 75 %. Läsionen mit spikulierter Berandung waren signifikant häufiger maligne als Läsionen mit glatter oder unscharfer Berandung (p < 0.05). Größe, Form oder vorhandene Nekrosen hatten keinen statistisch signifikanten Bezug zur Läsionsdignität (p > 0.05).

Schlussfolgerung: Die Spezifität der CT des Thorax ist zumeist nicht ausreichend für eine endgültige Diagnosestellung, sodass eine histologische Sicherung in der Mehrzahl der Fälle anzustreben ist. Einzig Läsionen mit spikulierter Berandung zeigten in der histopathologischen Evaluation einen signifikant höheren Anteil maligner Befunde.

• References

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