The diagnostic performance of chest radiographs for lung malignancy in symptomatic primary-care populations: A systematic review and meta-analysis

Abstract

Objectives: To synthesise existing evidence for the diagnostic accuracy of chest radiographs to detect lung malignancy in symptomatic patients presenting to primary care. Methods: A systematic review was performed and reported in accordance with the PRISMA framework, using a protocol prospectively registered with the PROSPERO database (CRD42020212450). Nine databases were searched for relevant studies. Data were extracted and chest radiograph sensitivity and specificity calculated where possible. Risk of bias was assessed using a validated tool. Random effects meta-analysis was performed. Results: Ten studies were included. Sensitivity meta-analysis was performed in five studies which were not the high risk of bias, with summary sensitivity of 81% (95% CI: 74–87%). Specificity could be calculated in five studies, with summary specificity of 68% (95% CI: 49–87%). Conclusions: The sensitivity of chest radiographs for detecting lung malignancy in primary care is relatively low. Physicians and policymakers must consider strategies to attenuate the possibility of false reassurance with a negative chest radiograph for this significant pathology. Options include widening access to cross-sectional imaging in primary care; however, any intervention would need to take into account the medical and financial costs of possible over-investigation. Prospective trials with long-term follow-up are required to further evaluate the risks and benefits of this strategy. Advances in knowledge: The chest radiograph has a sensitivity of 81% and specificity of 68% for lung malignancy in a symptomatic primary-care population. A negative chest radiograph does not exclude lung cancer, and physicians should maintain a low threshold to consider specialist referral or cross-sectional imaging.

Laterocervical lymph node metastases from suspected thyroidal primary site that turned out to be metastases of lung cancer: A case report

“…The sensitivity estimates for chest X‐ray spans from 76.8% (95% CI = 64.5 to 84.2%) to 79.7% (95% CI = 72.7 to 86.8%) considering similar primary care systems 17,18 . In symptomatic patients presenting to primary care, the sensitivity of chest radiograph to detect lung malignancy is 81%, with specificity 68% and this implies a high risk of false‐negative 19 . A key factor is nodule appearance.…”

“…In the index case, the chest radiograph before surgery failed to pick up the lesion. Chest X‐ray fails to identify LC (mostly initially) in more than 20% of people who are subsequently diagnosed with LC 19 . No one should be reassured by a negative chest radiograph if there is a high clinical suspicion for malignancy, and cross‐sectional imaging should be considered.…”

“…17 , 18 In symptomatic patients presenting to primary care, the sensitivity of chest radiograph to detect lung malignancy is 81%, with specificity 68% and this implies a high risk of false‐negative. 19 A key factor is nodule appearance. Lung lesions in apical, hilar, retrocardiac, and retro diaphragmatic locations as well as lesion size or density of nodules limit the detection rate in a routine posteroanterior chest radiography.…”

“…Chest X‐ray fails to identify LC (mostly initially) in more than 20% of people who are subsequently diagnosed with LC. 19 No one should be reassured by a negative chest radiograph if there is a high clinical suspicion for malignancy, and cross‐sectional imaging should be considered. Fortunately, low dose computed tomography (LDCT) has shown to be a potential tool for screening of LC in people at risk for exposure to tobacco smoke.…”

Guía de Práctica Clínica para el diagnóstico temprano y la referencia oportuna del cáncer de pulmón

“…La sensibilidad (81%) y especificidad (68%) son relativamente bajas para detectar neoplasias malignas, con una tasa de falsos negativos de 20%. 32 Se pueden encontrar imágenes sugerentes de neoplasia como las radiopacidades nodulares, derrame pleural, zonas de consolidación o ensanchamiento mediastinal.…”