Chest X-ray sensitivity and lung cancer outcomes: a retrospective observational study

Abstract

Background: Chest x-ray (CXR) is the first line investigation for lung cancer in many healthcare systems. Understanding of the consequences of false negative CXRs on time to diagnosis, stage and survival is limited. Aims: To determine the sensitivity of CXR for lung cancer and to compare stage at diagnosis, time to diagnosis and survival between those with CXR which detected, or did not detect, lung cancer. Design & Setting: Retrospective observational study using routinely collected healthcare data. Methods: All patients diagnosed with lung cancer in a teaching hospital trust during 2008 – 2015 who had a GP requested CXR in the year before diagnosis were categorised based on the result of the earliest CXR performed in that period. We calculated sensitivity of CXR and performed analyses with respect to time to diagnosis, survival and stage at diagnosis. Results: CXR was negative for 18% of patients (n=376/2129). Median time from initial CXR to diagnosis was 43 days (IQR: 27-78) for those with positive CXR and 204 days (105-287) for those with negative CXR. Of those with positive CXR, 29% (95% CIs 27-31%) were diagnosed at either stage I/II, compared to 34% (95% CIs 29-39%) of those with a negative CXR. Conclusion: GPs should consider lung cancer in patients with persistent symptoms even when CXR is negative. Despite longer duration to diagnosis for those with ‘false negative’ CXRs, there was no evidence of adverse impact on stage at diagnosis or survival; however this comparison is likely to be affected by confounding variables.

The Role of Smoking Status in Making Risk-Informed Diagnostic Decisions in the Lung Cancer Pathway: A Qualitative Study of Health Care Professionals and Patients

“…42 Chest X-ray is a cheap, low-radiation, and widely available test and provides valuable risk information. 43,44 Risk tools and guidelines could be developed specifically to consider whether to refer symptomatic never-smoker patients with a negative chest X-ray.…”

Utility of fluorescence-guided biopsy in suspected lung cancer patients with bronchial mucosal lesions

“…Lung cancer is a substantial challenge; it has high incidence and mortality rates, and it accounted for 12 to 13% of new cancer cases and approximately 22% of cancer-related deaths in the United States in 2021 [1] . Methods for diagnosing lung cancer have progressed due to medical research [2][3][4][5][6][7][8][9][10] .…”

“…However, patients with lung cancer are often diagnosed at advanced stages, of which 30% are at stage III and 40% are at stage IV, thus emphasizing the need r earlier diagnosis and more e cacious therapy [4][5] .…”

Utility of fluorescence-guided biopsy in suspected lung cancer patients with bronchial mucosal lesions

“…Lung cancer is a substantial challenge; it has high incidence and mortality rates, and it accounted for 12 to 13% of new cancer cases and approximately 22% of cancer-related deaths in the United States in 2021 [1] . Methods for diagnosing lung cancer have progressed due to medical research [2][3][4][5][6][7][8][9][10] . However, patients with lung cancer are often diagnosed at advanced stages, of which 30% are at stage III and 40% are at stage IV, thus emphasizing the need r earlier diagnosis and more e cacious therapy [4][5] .…”

“…Methods for diagnosing lung cancer have progressed due to medical research [2][3][4][5][6][7][8][9][10] . However, patients with lung cancer are often diagnosed at advanced stages, of which 30% are at stage III and 40% are at stage IV, thus emphasizing the need r earlier diagnosis and more e cacious therapy [4][5] .…”