Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review

Abstract

BackgroundDespite increasing use of computed tomography (CT), chest X-ray remains the first-line investigation for suspected lung cancer in primary care in the UK. No systematic review evidence exists as to the sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms.AimTo estimate the sensitivity of chest X-ray for detecting lung cancer in symptomatic people.Design and settingA systematic review was conducted to determine the sensitivity of chest X-ray for the detection of lung cancer.MethodDatabases including MEDLINE, EMBASE, and the Cochrane Library were searched; a grey literature search was also performed.ResultsA total of 21 studies met the eligibility criteria. Almost all were of poor quality. Only one study had the diagnostic accuracy of chest X-ray as its primary objective. Most articles were case studies with a high risk of bias. Several were drawn from non-representative groups, for example, specific presentations, histological subtypes, or comorbidities. Only three studies had a low risk of bias. Two primary care studies reported sensitivities of 76.8% (95% confidence interval [CI] = 64.5 to 84.2%) and 79.3% (95% CI = 67.6 to 91.0%). One secondary care study reported a sensitivity of 79.7% (95% CI = 72.7 to 86.8%).ConclusionThough there is a paucity of evidence, the highest-quality studies suggest that the sensitivity of chest X-ray for symptomatic lung cancer is only 77% to 80%. GPs should consider if further investigation is necessary in high-risk patients who have had a negative chest X-ray.

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

“…Our findings are consistent with a previous systematic review, which has suggested an estimate of 77 to 80% for the sensitivity of chest radiograph to detect lung malignancy in symptomatic patients. 5 This review did not focus on primary care, and only two studies were performed in a primary-care setting. These studies were also included in our review and analysis.…”

“…The chest radiograph is a key investigation in this approach, as National Institute of Clinical Evidence (NICE) referral guidelines state that any suspicious chest radiograph should provoke a TWR. 4 Systematic review methodology has previously been utilised to investigate the sensitivity of chest radiographs in symptomatic patients, 5 but to date there has been no systematic review assessing diagnostic accuracy of chest radiograph in a primary-care population. A directed investigation is warranted as difference in disease prevalence between primary and secondary care affects test performance.…”

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

“…Studies identified in a systematic review and a subsequently published study have estimated that CXR does not identify lung cancer in approximately 20-25% of cases. (5,6) The pooled number of individuals with lung cancer from these studies is relatively small (n=494) and definitions of positive and negative results was not entirely consistent between studies. Evidence regarding the consequences of false negative CXR results in terms of time to diagnosis, stage at diagnosis and survival is even more limited.…”

Charakterystyka radiofarmaceutyków stosowanych w diagnostyce raka płuca

“…Ze względu na niskie koszty oraz dostępność badania, RTG klatki piersiowej jest często stosowaną techniką. Ograniczeniem metody jest niska rozdzielczość przestrzenna obrazu i brak możliwości oceny miąższu płuc [3,6]. Badanie ce CT jest metodą z wyboru w ocenie guzów płuc, jednakże rzadko stanowi samodzielne narzędzie diagnostyczne, szczególnie w stagingu i restagingu.…”