Abstract: Objective The study is to examine the various factors that influence the precision of bronchoscopic lung biopsy and explore the diagnostic utility of a scoring system grounded on chest CT imaging characteristics. This will enable the development of a predictive model for assessing the diagnostic accuracy of transbronchoscopic biopsy, ultimately leading to the establishment of a streamlined scoring system. Method A retrospective analysis was conducted on 454 patients admitted to the Third People's Hospital of Shenzhen from January 2019 to June 2023, who were diagnosed with pulmonary lesions, underwent thin-layer CT scanning, and underwent successful bronchoscopy biopsy. The patients were divided into a positive group (323 cases) and a negative group (131 cases) based on whether their pathological diagnosis matched their clinical diagnosis. The basic clinical characteristics, pathological classification, and chest CT signs of the two groups were compared. Constructing a logistic prediction model based on chest CT imaging features to evaluate the accuracy of bronchoscopic biopsy. Result Among 454 patients in this study. The pathological diagnosis of biopsy tissue matched the clinical diagnosis, with 323 cases in the positive group. The overall accuracy rate of bronchoscopy biopsy was 71.15%. Statistically significant differences were observed between the positive and negative groups regarding CT imaging characteristics of the chest, including lesion size, bronchial grading, presence or absence of the bronchial insufflation sign, and morphological characteristics of the lesion (P<0.05). Notably, bronchial grading and the presence or absence of the bronchial insufflation sign emerged as predictive factors for biopsy accuracy. A logistic prediction model was developed based on these two factors, yielding an area under the ROC curve of 0.787 (95%CI 0.737-0.836, P<0.001). Additionally, a simplified scoring formula was established, resulting in an area under the ROC curve of 0.735 (95%CI 0.684-0.786, P<0.001). Conclusion Bronchial grading and the bronchial insufflation sign serve as predictive imaging factors for the precision of transbronchoscopic biopsy, while a scoring system derived from chest CT imaging characteristics demonstrates effective clinical utility in diagnosing transbronchoscopic biopsy.

Key words: Chest computed tomography, Imaging signs, Bronchoscopic biopsy, Scoring system