Chest X-ray in suspected lung cancer is harmful.

Abstract

OBJECTIVES:

The aim of this study was to analyse the use of the chest radiograph (CXR) as the first-line investigation in primary care patients with suspected lung cancer.

METHODS:

Of 16,945 primary care referral CXRs (June 2018 to May 2019), 1,488 were referred for suspected lung cancer. CXRs were coded as follows: CX1, normal but a CT scan is recommended to exclude malignancy; CX2, alternative diagnosis; or CX3, suspicious for cancer. Kaplan-Meier survival analysis was undertaken by stratifying patients according to their CX code.

RESULTS:

In the study period, there were 101 lung cancer diagnoses via a primary care CXR pathway. Only 10% of patients with a normal CXR (CX1) underwent subsequent CT and there was a significant delay in lung cancer diagnosis in these patients (p < 0.001). Lung cancer was diagnosed at an advanced stage in 50% of CX1 patients, 38% of CX2 patients and 57% of CX3 patients (p = 0.26). There was no survival difference between CX codes (p = 0.42).

CONCLUSION:

Chest radiography in the investigation of patients with suspected lung cancer may be harmful. This strategy may falsely reassure in the case of a normal CXR and prioritises resources to advanced disease.

KEY POINTS:

• Half of all lung cancer diagnoses in a 1-year period are first investigated with a chest X-ray. • A normal chest X-ray report leads to a significant delay in the diagnosis of lung cancer. • The majority of patients with a normal or abnormal chest X-ray have advanced disease at diagnosis and there is no difference in survival outcomes based on the chest X-ray findings.

• Authors: Robert W Foley, Vanessa Nassour, Helen C Oliver, Toby Hall, Vidan Masani, Graham Robinson, Jonathan C L Rodrigues, Benjamin J Hudson
• Journal: European radiology (Eur Radiol) Vol. 31 Issue 8 Pg. 6269-6274 (Aug 2021) ISSN: 1432-1084 [Electronic] Germany
• PMID: 33517491 (Publication Type: Journal Article)
• Copyright: © 2021. Crown.

Topics

• Humans
• Lung
• Lung Neoplasms (diagnostic imaging)
• Radiography
• Radiography, Thoracic
• Tomography, X-Ray Computed
• X-Rays