{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T08:52:28Z","timestamp":1782118348264,"version":"3.54.5"},"reference-count":28,"publisher":"King Faisal Specialist Hospital and Research Centre","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Saudi Med"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Managing small Lung-RADS 4 pulmonary nodules is clinically challenging. While CT-guided TTFNAB is standard, its efficacy and safety for lesions \u22642 cm require further evaluation to optimize outcomes and reduce unnecessary surgeries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>This study aimed to evaluate the diagnostic accuracy, safety, and factors influencing the outcomes of CT-guided TTFNAB in Lung-RADS category 4 pulmonary nodules measuring \u22642 cm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN:<\/jats:title>\n                    <jats:p>Retrospective study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTING:<\/jats:title>\n                    <jats:p>Single-center, a tertiary referral center<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>A retrospective analysis was performed on 95 patients who underwent CT-guided TTFNAB between January 2021 and April 2024. Data included demographics, lesion characteristics (size, location, density, and pleural proximity), histopathological findings, and procedural outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MAIN OUTCOME MEASURES:<\/jats:title>\n                    <jats:p>The primary endpoints were diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and factors influencing TTFNAB results, alongside procedural complications\u2014specifically pneumothorax and chest tube requirement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SAMPLE SIZE:<\/jats:title>\n                    <jats:p>95 patients<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of the 95 nodules, 26 (27%) were benign and 69 (73%) were malignant according to TTFNAB. Final pathology confirmed 18 (19%) benign and 77 (81%) malignant lesions. All biopsies yielded sufficient material. Sensitivity, specificity, and overall diagnostic accuracy were 83%, 94%, and 89%, respectively. The PPV was 98%, while the NPV was 65%. Pleural thickening was significantly more frequent in both the TTFNAB benign group (38% vs. 13%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =.006) and final benign diagnosis group (44% vs. 14%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =.008). Pneumothorax occurred in 30% of cases, with 24% of these requiring chest tube drainage. No significant associations were found between diagnostic accuracy or complications and variables such as age, emphysema, Lung-RADS category, or nodule size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>CT-guided TTFNAB is an effective diagnostic method for confirming malignancy in pulmonary nodules \u22642 cm classified as Lung-RADS 4, providing an overall accuracy of 89% and a PPV of 98%. However, a benign TTFNAB result cannot be considered diagnostically safe: the NPV of 65% and false-negative rate of 35% indicate that a negative biopsy does not reliably exclude malignancy. Clinicians must not rely on a negative result alone; close radiological follow-up or surgical biopsy is essential for these high-risk lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LIMITATIONS:<\/jats:title>\n                    <jats:p>The retrospective single-center design, small sample size, and limited generalizability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IRB APPROVAL NUMBER:<\/jats:title>\n                    <jats:p>2024\/010.99\/6\/23 (Date: 26.07.2024)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5144\/0256-4947.2026.225","type":"journal-article","created":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T08:38:07Z","timestamp":1780821487000},"page":"225-233","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic utility and limitations of CT-guided transthoracic fine-needle aspiration biopsy in Lung-RADS 4 pulmonary nodules \u22642 cm"],"prefix":"10.5144","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5174-6457","authenticated-orcid":true,"given":"S\u00fcmeyye Kodalak","family":"Cengiz","sequence":"first","affiliation":[{"name":"From the Department of Pulmonary Medicine, Gazi University Faculty of Medicine, Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ersin","family":"Demirer","sequence":"additional","affiliation":[{"name":"From the Department of Pulmonology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer","family":"Baysal","sequence":"additional","affiliation":[{"name":"From the Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u0131dvan","family":"Dizman","sequence":"additional","affiliation":[{"name":"From the Department of Radiology, Kahta State Hospital, Adiyaman, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Fidan","sequence":"additional","affiliation":[{"name":"From the Department of Pulmonology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonca G\u00fcl","family":"Ge\u00e7men","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Recep","family":"Demirhan","sequence":"additional","affiliation":[{"name":"From the Department of Thoracic Surgery, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevda \u015eener","family":"C\u00f6mert","sequence":"additional","affiliation":[{"name":"From the Department of Pulmonology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3134","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/8192832"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.19.21206"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00197-2021"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2020.05.019"},{"key":"e_1_3_2_6_2","unstructured":"American College of Radiology. 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