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Purpose: We investigated factors predictive of false-negative pulmonary lesions with nonspecific benign cytology results on percutaneoustransthoracic fine-needle aspiration biopsy (FNAB). Materials and Methods: We included 222 pulmonary lesions that had a nonspecific benign result from percutaneous transthoracicFNAB between March 2005 and December 2012, and were confirmed by subsequent pathologic results or adequate clinical followup over at least 2 years. Clinical, imaging, and biopsy procedure-related findings were compared between lesions with a finaldiagnosis of malignancy (false-negative) and lesions with a benign diagnosis (true-negative). Multivariate logistic regression analysiswas performed to identify significant predictors of false-negatives. Results: Of 222 lesions, 115 lesions were proved to be false-negatives, and 107 were true-negatives. Compared with the true-negatives,false-negative lesions showed significantly older age (p=0.037), higher maximum standardized uptake value (SUVmax) onpositron emission tomography (p=0.001), larger lesion size (p=0.007), and lesion characteristics of a subsolid nodule (p=0.007). On multivariate logistic regression analysis, SUVmax, lesion size, and lesion characteristics were significant predictors of falsenegativeresults. Conclusion: Among the clinical, radiologic, and procedure-related factors analyzed, high SUVmax, large lesion size, and subsolidlesions were useful for predicting malignancy in pulmonary lesions with nonspecific benign cytology results on FNAB.

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