Bradley, S, Bradley, S, Abraham, S orcid.org/0000-0001-8786-3789 et al. (6 more authors) (2018) Sensitivity of chest X-ray for lung cancer: systematic review. British Journal of General Practice, 68 (suppl 1). bjgp18X696. ISSN 0960-1643
Abstract
Background: Lung cancer is a leading cause of premature death. Early diagnosis is associated with improved outcomes. While chest X-ray remains the first line investigation, individual studies have indicated that a proportion of lung cancers are not identified (false negatives); this is one cause of delayed diagnoses.
Aim: To estimate the proportion of patients with lung cancer who have had a chest X-ray in the year prior to diagnosis which was not interpreted as having features suspicious for lung cancer.
Method: A broad search strategy was devised including several synonyms for chest X-ray and lung cancer. Screening and paediatric data, studies from before 1999 and studies based on retrospective interpretation of radiology were excluded. A 20% random sample screened by a second reviewer to ensure consistency.
Results: Analysis is almost complete: 8362 studies were identified. Twenty-nine studies met the inclusion criteria. Heterogeneity precluded meta-analysis, however the combined population was 1557 patients of whom 954 (61.27%) had a positive chest X-ray. In four studies with a lower risk of bias, comprising 1052 patients, sensitivity ranged from 73.5% to 79.3% (mean 76.19%).
Conclusion: This review suggests that chest X-ray does not identify approximately 25% of cases, although the findings may be affected by publication bias. This finding needs replicating in a high-quality study that could also demonstrate the potential consequences on diagnostic intervals and stage at diagnosis. The findings also suggest that studies to evaluate the effectiveness and cost-effectiveness of other modalities (e.g. low-dose CT scan) are needed.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 19 Oct 2018 10:34 |
Last Modified: | 19 Oct 2018 10:34 |
Status: | Published |
Publisher: | Royal College of General Practitioners |
Identification Number: | 10.3399/bjgp18X696905 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:137387 |