Machine learning predicts severe adverse events and salvage success of CT-guided lung biopsy after nondiagnostic transbronchial lung biopsy.

Abstract

To address the unmet clinical need for validated risk stratification tools in salvage CT-guided percutaneous lung biopsy (PNLB) following nondiagnostic transbronchial lung biopsy (TBLB). We aimed to develop machine learning models predicting severe adverse events (SAEs) in PNLB (Model 1) and diagnostic success of salvage PNLB post-TBLB failure (Model 2). This multicenter predictive modeling study enrolled 2910 cases undergoing PNLB across two centers (Center 1: n = 2653 (2016-2020); Center 2: n = 257 (2017-2022)) with complete imaging and clinical documentation meeting predefined inclusion and exclusion criteria. Key variables were selected via LASSO regression, followed by development and validation of Model 1 (incorporating sex, smoking, pleural contact, lesion size, and puncture depth) and Model 2 (including age, lesion size, lesion characteristics, and post-bronchoscopic pathological categories (PBPCs)) using ten machine learning algorithms. Model performance was rigorously evaluated through discrimination metrics, calibration curves, and decision curve analysis to assess clinical applicability. A total of 2653 and 257 PNLB cases were included from two centers, where Model 1 achieved external validation ROC-AUC 0.717 (95% CI: 0.609-0.825) and PR-AUC 0.258 (95% CI: 0.0365-0.708), while Model 2 exhibited ROC-AUC 0.884 (95% CI: 0.784-0.984) and PR-AUC 0.852 (95% CI: 0.784-0.896), with XGBoost outperforming other algorithms. The dual XGBoost system stratifies salvage PNLB candidates by quantifying SAE risks (AUC = 0.717) versus diagnostic yield (AUC = 0.884), addressing the unmet need for personalized biopsy pathway optimization. Question Current tools cannot quantify severe adverse event (SAE) risks versus salvage diagnostic success for CT-guided lung biopsy (PNLB) after failed transbronchial biopsy (TBLB). Findings Dual XGBoost models successfully predicted the risks of PNLB SAEs (AUC = 0.717) and diagnostic success post-TBLB failure (AUC = 0.884) with validated clinical stratification benefits. Clinical relevance The dual XGBoost system guides clinical decision-making by integrating individual risk of SAEs with predictors of diagnostic success, enabling personalized salvage biopsy strategies that balance safety and diagnostic yield.