Diagnostic value of surgical lung biopsy: comparison with clinical and radiological diagnosis☆

Abstract

Objective: To determine overall and disease-related accuracy of the clinical/imagiological evaluation for pulmonary infiltrates of unknown aetiology, compared with the pathological result of the surgical lung biopsy (SLB) and to evaluate the need for the latter in this setting. Methods: We conducted a retrospective review of the experiences of SLB in 366 consecutive patients during the past 5 years. The presumptive diagnosis was based on clinical, imagiological and non-invasive or minimally invasive diagnostic procedures and compared with the gold standard of histological diagnosis by SLB. We considered five major pathological groups: diffuse parenchymal lung disease (DPLD), primitive neoplasms, metastases, infectious disease and other lesions. Patients with previous histological diagnosis were excluded. Results: In 56.0% of patients (n = 205) clinical evaluation reached a correct diagnosis, in 42.6% a new diagnosis was established (n = 156) by the SLB, which was inconclusive in 1.4% (n = 5). The pre-test probability for each disease was 85% for DPLD, 75% for infectious disease, 64% for primitive neoplasms and 60% for metastases. Overall sensitivity, specificity, positive and negative predictive values for the clinical/radiological diagnosis were 70%, 90%, 62% and 92%, respectively. For DPLD: 67%, 90%, 76% and 85%; primitive neoplasms: 47%, 90%, 46% and 90%; metastases: 99%, 79%, 60% and 99%; infectious disease 38%, 98%, 53% and 96%. Conclusions: Despite a high sensitivity and specificity of the clinical and imagiological diagnosis, the positive predictive value was low, particularly in the malignancy group. SLB should be performed in pulmonary infiltrates of unknown aetiology because the clinical/imagiological assessment missed and/or misdiagnosed an important number of patients. #

How accurate is the clinical and radiological evaluation of orbital lesions in comparison to surgical orbital biopsy?

“…the proportion of correct clinical positive diagnoses among all histopathologically verified diagnoses of lesions) [1].The positive predictive value (PPV) of the clinical diagnosis is the probability of a clinically based, positive diagnosis of a lesion being correct, expressed as the proportion of histopathologically verified, positive clinical diagnoses among all positive clinical diagnoses [1].The same applies for radiological diagnosis. PPV measures the rate of accuracy [2].…”

Diagnostic yield and postoperative mortality associated with surgical lung biopsy for evaluation of interstitial lung diseases: A systematic review and meta-analysis

“…The median diagnostic yield was 95% (range, 42%-100%), with only 1 study achieving less than 70%, 7 8 studies achieving 70% to 90%, [8][9][10][11][12][13][14][15] 8 studies achieving 90% to 100%, 5,16-20 and 6 studies achieving 100%. 6,[21][22][23][24][25] Moreover, 8 studies evaluated the frequency in which the biopsy changed the treatment algorithm, ranging from 42% to 90%. 7,8,10,15,18,20,22,24 The change was driven by specific diagnosis in 6 studies 8,15,18,20,22,24 and was not necessarily related to specific diagnosis in 2 studies.…”

Do the Number and Volume of Surgical Lung Biopsies Influence the Diagnostic Yield in Interstitial Lung Disease? A Propensity Score Analysis

“…3,4 Indeed, the decision to perform SLB in these patients is based on the likelihood that pathologic examination of the tissue obtained will yield relevant features for a confident diagnosis or specific information about the cause of the disease process. 5,6 Therefore, it is crucial to ascertain the optimal number and volume of SLBs in order to improve diagnostic yield. Few studies have attempted to identify these factors.…”