Outcomes and Clinical Practices in Follow-Up of Nonmalignant Pulmonary Nodules After Bronchoscopic Biopsy

Background: Management of nonmalignant nodules after bronchoscopic biopsy lacks thorough investigation, leading to varied clinical approaches. Research Question: What are the true-negative and false-negative rates of nonmalignant nodules by bronchoscopic biopsy, and what is the clinical practice pattern for follow-up? Study Design and Methods: A retrospective review was conducted for pulmonary nodules biopsied via bronchoscopy between 2019 and 2020 revealing no malignancy. True-negative and false-negative rates were calculated. Clinical practice patterns for repeat biopsy and follow-up imaging studies were analyzed using time-to-event analysis. Covariates, including sex, age, smoking history, nodule size, maximum standardized uptake values, active cancer diagnosis, bronchoscopy type, and nodule pathologic findings, were evaluated for their impact on clinical decision-making. Results: Among 136 patients with 139 nodules analyzed, only 39.6% of nodules were classified definitively as benign (true-negative rate), whereas 23.7% of nodules were deemed malignant (false-negative rate). Repeat biopsy was performed for 35.3% of nodules, and 66.9% of patients underwent follow-up CT imaging. Nodules initially diagnosed with suspicious or atypical pathologic results reached a final diagnosis (hazard ratio, 3.65; 95% CI, 1.33-9.99) earlier than those with nondiagnostic pathologic findings. Patients with such nodules underwent repeat biopsy sooner (χ2 = 15.85; P = .000) and exhibited a trend toward earlier repeat CT scans (χ2 = 5.93; P = .052). Interpretation: After bronchoscopic biopsy, a 2-year follow-up revealed a notable lack of high true-negative rates for nonmalignant nodules, alongside significant false-negative rates. Diverse clinical practices, including repeat biopsy and follow-up CT scans, were observed in managing nonmalignant nodules.