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Year : 2016  |  Volume : 2  |  Issue : 3  |  Page : 120-126

Chest radiographs and the elusive lung cancer

1 Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
2 Department of Radiology, Royal Infirmary of Edinburgh; Clinical Research and Imaging Centre, Edinburgh, Scotland, UK
3 Clinical Research and Imaging Centre, Edinburgh, Scotland, UK

Correspondence Address:
Andrew E Walker
Department of Radiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, EH16 4SA, Edinburgh, Scotland
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2226-8561.194700

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Background and Objectives: Lung cancer is the commonest cancer killer in the western world. Many patients have lung cancers first identified on chest radiograph (CXR). Potentially curable cancers are often missed on CXR. This study quantified the incidence of cases of lung cancer which were initially overlooked and studied the causes of delayed diagnosis. Materials and Methods: All consecutive patients discussed during a 3-month period at the local lung cancer multidisciplinary meeting (MDM) were identified. All imaging within two years prior to diagnosis of lung cancer were reviewed with its report. Any CXR examination which failed to raise the potential for lung cancer was blindly reviewed by four consultant chest radiologists. Results: 189 patients were identified from the MDM over three months. 38,049 CXRs were carried out in the trust over the same period. Of the 189 patients, 58 had previous CXRs within 2 years reported as normal. On review 27 (47%) showed an abnormality in the region of the lung subsequently shown to have cancer. 70% of lesions were central, obscured by the heart, diaphragm, clavicles or mediastinum. Conclusions: This study shows that 1 in 1,409 CXRs reported as normal harbours a visible lung cancer on retrospective review. In this group 14% of patients with lung cancer could potentially have been diagnosed earlier. Of those that had previous CXRs, 47% had abnormal CXRs reported as normal. This study qualifies the rate of missed lung cancer on CXR in clinical practice and highlights where on CXR cancers are missed.

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