The Lateral Radiograph for Early Diagnosis of Lung Cancer

Forrest, John V.; Sagel, Stuart S.

doi:10.1148/131.2.309

Cited by 20 publications

(11 citation statements)

References 2 publications

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“…16 A nodule was rarely detected only by the examination with two radiographs after being missed in the PA projection. The frequency in our study for this case was 4.2% (n 5 15) and is thus comparable with the data of Forrest et al 17 Our study has several limitations. First, the number of reviewed CXR is rather small, which prevents a generalization of our results.…”

supporting

confidence: 90%

The additional value of the lateral chest radiograph for the detection of small pulmonary nodules—a ROC analysis

Kluthke¹,

Kickuth²,

Bansmann³

et al. 2016

BJR

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Results:The mean Az value of the sole PA view was 0.75 and 0.77 by the combination of PA and additional lateral view. So, there was no significant difference between the detectable Az values (D 5 0.02; p 5 0.384). With a cut-off value of .3, the additional view even reduced the sensitivity by averaging to 5.6%. The decrease of sensitivity by using the additional view was most detectable within the group of more experienced radiologists. Conclusion: The additional lateral view of the chest provides no diagnostic benefit in the detection of small pulmonary nodules in comparison with the sole PA projection. Nevertheless, the results of the present study must not be understood as a general evaluation of the benefits of the lateral radiograph per se, because we did not examine other relevant issues (i.e. cardiac failure, lung parenchyma diseases or abnormalities in hilar anatomy). Advances in knowledge: Our study demonstrates a lack of evidence for any diagnostic benefit of the additional lateral view of the thorax in detecting SPN.

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supporting

confidence: 90%

The additional value of the lateral chest radiograph for the detection of small pulmonary nodules—a ROC analysis

Kluthke¹,

Kickuth²,

Bansmann³

et al. 2016

BJR

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“…Other authors reported a rate of 2% to 4% of lung cancers seen only on the LL projection (13,22,26). On the other hand, Forrest et al (27) and Sagel et al (28) observed that all lung cancers were visible on frontal X-ray, suggesting that lateral radiography was unnecessary.…”

Section: Technical Considerationsmentioning

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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“…The stem line fortuitously aligns with the rounded lucency of the left main-upper lobe continuum (Figs. 8,9) on the well-positioned lateral radiograph. Approximated posteriorly by azygoesophageal recess, it is normally visible as a thin vertical line projecting right through the lucent end-on bronchus of the slightly more posterior left hilum (Fig.…”

Section: Trachea and Bronchimentioning

confidence: 98%

“…Mobile X-ray machines became a common site in public locations by the 1950s and 1960s. Medical literature emerged during the 1960s and 1970s addressing limitations of the posteroanterior (PA) chest radiograph and the efficacy of other views, and enlightening radiologists to normal anatomy visible on the lateral view (7)(8)(9)(10)(11).…”

mentioning

confidence: 99%

The Chest in Profile

McComb¹

2002

Journal of Thoracic Imaging

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Radiology has been abounding with technological advances since the chest film first became the mainstay in diagnosing thoracic disease, and yet the conventional chest examination has endured as a front-line tool. The ability to perceive structural alterations is facilitated by a solid foundation in anatomy, which should be easy to achieve in a practice environment in which CT has become so commonplace. Not only is knowledge of anatomic nuances important for analysis of conventional radiographs, but it can only be an asset as multiplanar imaging is increasingly utilized and new modalities are developed over time. Some fundamental anatomic variations are revisited here through correlating the perspective provided by the lateral radiograph with the equally common one provided by routine axial CT images.

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The Lateral Radiograph for Early Diagnosis of Lung Cancer

Cited by 20 publications

References 2 publications

The additional value of the lateral chest radiograph for the detection of small pulmonary nodules—a ROC analysis

The additional value of the lateral chest radiograph for the detection of small pulmonary nodules—a ROC analysis

Missed lung cancer: when, where, and why?

The Chest in Profile

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