Primary carcinoma of the lung overlooked at CT: analysis of findings in 14 patients.

White, Charles S.; Romney, Benjamin; Mason, Aaron; Austin, John; Miller, Barry; Protopapas, Zenon

doi:10.1148/radiology.199.1.8633131

Cited by 86 publications

(35 citation statements)

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“…White et al demonstrated that endobronchial location and lower lobe predominance were the most common characteristics of overlooked lung cancer on CT scan. 10 Patz et al described that non-enhanced CT thorax through adrenal gland is sufficient for successful staging and contrast-enhanced CT (CECT) thorax did not substantially alter the tumor staging. 11 However, in this study CECT was done in majority of the patients to differentiate necrotic part of the tumor through which biopsy should be avoided and it was helpful in distinguishing central partially obstructing endobronchial mass from more distal collapsed or consolidated lung.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and staging of lung carcinoma with CT scan and its histopathological correlation

et al. 2017

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INTRODUCTIONLung carcinomas are a group of tumors that arise from any part of trachea, bronchi, bronchioles or the pulmonary parenchyma and can be derived from the cells of epithelium, mesenchyme and neural origin. Thus, it is a heterogenous entity both in the variety of cell type and in the biological behaviour of any particular cell type. Bronchogenic carcinoma is the most common cause of cancer-related death in men and second most common in women, worldwide. Imaging studies play a key role in the detection, staging and post-treatment follow up of patients with bronchogenic carcinoma. The strongest prognostic factor for survival in lung cancer cases is respectability of the tumor. Thus, accurate staging of the bronchogenic carcinoma is essential as the choice of treatment options ABSTRACT Background: Lung cancer is the most common cancer worldwide. Hence, timely diagnosis and accurate staging of the carcinoma is critical for the treatment and prognosis. So, this study was performed to evaluate the role of CT scan in diagnosis and staging of lung cancer. Methods: This was a prospective and observational study carried out over one and half years at a tertiary care hospital. The patients found to have abnormalities on chest X-ray suggestive of carcinoma were included in the study. Pre and post contrast CT scans were performed. Individual patient biopsies were done for histopathological staging. Results: Most patients belonged to 41-50 years age group with male preponderance (81.33%). Habit of smoking was prevalent among the lung cancer patients. Almost all masses (92%) showed heterogeneous contrast enhancement on CT. Additionally, there were calcifications, cavitation, hilar enlargement, pleural invasion, mediastinal lymphadenopathy and contiguous bone involvement. Adenocarcinoma was the most common (46.66%) form of cancer followed by squamous cell carcinoma (42.66%). For histopathological diagnosis, majority of patients (73.33%) were diagnosed using CT guided biopsy. In the remaining patients, USG guided biopsy or fibreoptic bronchoscopy were performed. The most common lobe affected by bronchogenic carcinoma was right upper lobe. The most common site of metastasis was pleura (22.66%) followed by bone (17.33%). Majority of the patients (41.33%) presented with TNM stage IV. Conclusions: CT scan as a modality for detection and staging of bronchogenic carcinoma is superior to chest radiograph. CT guided FNAC has a high success rate in evaluation of lung carcinoma.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and staging of lung carcinoma with CT scan and its histopathological correlation

et al. 2017

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“…White et al (47) described location, shape and cell type of 15 lung cancers overlooked at CT and observed that the majority of these cancers had endobronchial location with lower lobe predominance. Gurney et al (48) documented nine lung tumors missed at CT, five of which were peripheral and four were central.…”

Section: Factors Leading To Missed Lung Cancer On Chest Ctmentioning

confidence: 99%

Missed lung cancer: when, where, and why?

Ciello

Franchi²,

Contegiacomo³

et al. 2017

Diagn Interv Radiol

132

106

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L ung cancer accounts for 1.59 million deaths per year worldwide (1). It has one of the poorest survival outcomes of all cancers, with over two-thirds of patients diagnosed at an advanced stage, when curative treatment is no longer feasible. Early diagnosis of lung cancer is the main goal to improve survival. Patients with non-small cell lung cancer (NSCLC) at an operable stage have higher survival rates than those presenting with metastatic disease, with five-year survival of 71%-77% for stage IA and 58% for stage IB (2).Initial identification of lung cancer in asymptomatic patients usually occurs on chest radiography or chest computed tomography (CT). When missed on imaging, lung cancer is inclined to progress from early-stage to advanced-stage disease, particularly if many years pass between radiologic exams (3), with potential medicolegal consequences.Legal actions involving malignancies of the bronchus or lung represent the sixth most common medicolegal issue, and among radiologists it is the second most common cause for litigation (4). About 90% of presumed mistakes in pulmonary tumor diagnosis occurred on chest radiography, only 5% on CT examinations, and the remaining 5% on other imaging studies (4).Awareness of the possible causes for overlooking a pulmonary lesion can help radiologists to reduce the occurrence of this eventuality. In this review, we analyze factors leading to a misdiagnosis of lung cancer mainly on chest radiography, and we discuss the impact of misdiagnosis on prognosis, its medicolegal implications, and methods to reduce the incidence of missed lung cancer. Finally, we briefly analyze the possible causes of errors on CT scans and potential aids. Factors leading to missed lung cancer on chest radiographyFormerly, different authors recognized the burden of missed lung cancer on radiography of the thorax. Indeed, early studies on the analysis of factors leading to overlooked lung lesions date back to the middle of last century. Despite extensive technological advancement, this issue is currently present and not much has changed since then. Factors that contribute to missed lung cancer on chest X-ray can be classified as deriving from observer error, tumor characteristics, and technical considerations. C H E S T I MAG I N G R E V I E W ABSTRACTMissed lung cancer is a source of concern among radiologists and an important medicolegal challenge. In 90% of the cases, errors in diagnosis of lung cancer occur on chest radiographs. It may be challenging for radiologists to distinguish a lung lesion from bones, pulmonary vessels, mediastinal structures, and other complex anatomical structures on chest radiographs. Nevertheless, lung cancer can also be overlooked on computed tomography (CT) scans, regardless of the context, either if a clinical or radiologic suspect exists or for other reasons. Awareness of the possible causes of overlooking a pulmonary lesion can give radiologists a chance to reduce the occurrence of this eventuality. Various factors contribute to a misdiagnosis of lung cancer ...

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“…high sensitivity-is underscored by the fact that many failures in lung cancer diagnosis are due to errors of detection rather than interpretation. 19,20 Therefore, based on our initial data, we could not conclude that radiographers were suitable to act as first readers in CT lung cancer screening. This is because we found that radiographer sensitivity in the majority of cases was statistically significantly lower than that of the radiologists reading the same CTs.…”

Section: Discussionmentioning

confidence: 89%

Comparing the performance of trained radiographers against experienced radiologists in the UK lung cancer screening (UKLS) trial

Nair

Gartland

Barton

et al. 2016

BJR

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Primary carcinoma of the lung overlooked at CT: analysis of findings in 14 patients.

Abstract: Endobronchial location and lower lobe predominance were the most common characteristics of overlooked lung cancer at CT. The presence of unrelated major abnormalities at CT may also have contributed to failure to diagnose the tumor.

Cited by 86 publications

References 0 publications

Diagnosis and staging of lung carcinoma with CT scan and its histopathological correlation

Diagnosis and staging of lung carcinoma with CT scan and its histopathological correlation

Missed lung cancer: when, where, and why?

Comparing the performance of trained radiographers against experienced radiologists in the UK lung cancer screening (UKLS) trial

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