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.
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Abbreviations
- ANOVA:
-
Analysis of variance
- CT:
-
Computed tomography
- CX1:
-
Normal chest radiograph
- CX2:
-
Alternative diagnosis on chest radiograph
- CX3:
-
Suspicion for malignancy on chest radiograph
- CXR:
-
Chest radiograph
- NICE:
-
National Institute for Health and Care Excellence
- TNM:
-
Tumour, node, metastasis
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The scientific guarantor of this publication is Benjamin J Hudson.
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Foley, R.W., Nassour, V., Oliver, H.C. et al. Chest X-ray in suspected lung cancer is harmful. Eur Radiol 31, 6269–6274 (2021). https://doi.org/10.1007/s00330-021-07708-0
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DOI: https://doi.org/10.1007/s00330-021-07708-0