A prospective cohort evaluation of the sensitivity and specificity of the chest X-ray for the detection of lung cancer in symptomatic adults

Bobby S K Bhartia; Nathaniel Luke Fielding Hatton; Rehima Aslam; Stephen H Bradley; Michael Darby; William T Hamilton; Emily Hurst; Martyn P T Kennedy; Luke T A Mounce; Richard D Neal; Bethany Shinkins; Matthew E J Callister

doi:10.1016/j.ejrad.2021.109953

A prospective cohort evaluation of the sensitivity and specificity of the chest X-ray for the detection of lung cancer in symptomatic adults

Eur J Radiol. 2021 Nov:144:109953. doi: 10.1016/j.ejrad.2021.109953. Epub 2021 Sep 20.

Affiliations

¹ Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: b.bhartia@nhs.net.
² Leeds Institute of Health Sciences, University of Leeds, UK.
³ Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁴ Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁵ College of Medicine & Health, University of Exeter, UK.

PMID: 34560505
DOI: 10.1016/j.ejrad.2021.109953

Abstract

Background: The accuracy of the chest x-ray (CXR) in the identification of lung cancer amongst symptomatic individuals is uncertain.

Purpose: To determine the diagnostic accuracy of the CXR for the detection of non-small cell carcinomas (NSCLC) and all primary intrathoracic malignancies.

Methods: A prospective cohort study of consecutive CXR reports obtained within a primary care open access initiative. Eligibility criteria were symptoms specified by National Institute for Clinical Excellence as indicative of possible lung cancer and age over 50-yrs. A positive test was a CXR which led directly or indirectly to investigation with CT. The reference standards were malignancies observed within a one- or two-year post-test period.

Results: 8,948 CXR outcomes were evaluated. 496 positive studies led to a diagnosis of 101 patients with primary intrathoracic malignancy including 80 with NSCLC. Within two-years, a cumulative total of 168 patients with primary intrathoracic malignancies including 133 NSCLC were observed. The sensitivity and specificity for NSCLC were 76% (95 %CI 68-84) and 95% (95 %CI 95-96) within 1-year and 60% (95 %CI 52-69) and 95% (95 %CI 95-96) within 2-years. The 2-yr positive and negative likelihood ratios were 12.8 and 0.4. The results did not differ for NSCLC compared to all primary malignancies. Within this symptomatic population a negative test reduced the 2-year risk of lung cancer to 0.8%.

Conclusions: A positive test strongly increases the probability of malignancy whereas a negative test does not conclusively exclude the disease. The findings allow the risk of malignancy following a negative test to be estimated.

Keywords: Chest Radiograph; Diagnostic Accuracy; Lung Cancer.

MeSH terms

Adult
Cohort Studies
Humans
Lung Neoplasms* / diagnostic imaging
Middle Aged
Prospective Studies
Radiography, Thoracic
Sensitivity and Specificity
X-Rays