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Intended for Healthcare Professionals
British Journal of General Practice

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Sensitivity of chest X-ray for lung cancer: systematic review

Stephen Bradley, Stephen Bradley, Sarah Abraham, Adam Grice, Rocio Rodriguez Lopez, Judy Wright, Tracey Farragher, Beth Shinkins and Richard D Neal
British Journal of General Practice 2018; 68 (suppl 1): bjgp18X696905. DOI: https://doi.org/10.3399/bjgp18X696905
Stephen Bradley
Academic Unit of Primary Care, University of Leeds, Leeds Email:
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  • For correspondence: medsbra@leeds.ac.uk
Stephen Bradley
Academic Unit of Primary Care, University of Leeds, Leeds
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Sarah Abraham
Test Evaluation Group, Leeds Institute of Health Sciences, University of Leeds, Leeds
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Adam Grice
Academic Unit of Primary Care, University of Leeds, Leeds
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Rocio Rodriguez Lopez
Leeds Institute of Health Sciences, University of Leeds, Leeds
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Judy Wright
Leeds Institute of Health Sciences, University of Leeds, Leeds
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Tracey Farragher
Academic Unit of Primary Care, University of Leeds, Leeds
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Beth Shinkins
Test Evaluation Group, Leeds Institute of Health Sciences, University of Leeds, Leeds
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Richard D Neal
Academic Unit of Primary Care, University of Leeds, Leeds
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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.

  • © British Journal of General Practice 2018
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British Journal of General Practice: 68 (suppl 1)
British Journal of General Practice
Vol. 68, Issue suppl 1
June 2018
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Sensitivity of chest X-ray for lung cancer: systematic review
Stephen Bradley, Stephen Bradley, Sarah Abraham, Adam Grice, Rocio Rodriguez Lopez, Judy Wright, Tracey Farragher, Beth Shinkins, Richard D Neal
British Journal of General Practice 2018; 68 (suppl 1): bjgp18X696905. DOI: 10.3399/bjgp18X696905

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Sensitivity of chest X-ray for lung cancer: systematic review
Stephen Bradley, Stephen Bradley, Sarah Abraham, Adam Grice, Rocio Rodriguez Lopez, Judy Wright, Tracey Farragher, Beth Shinkins, Richard D Neal
British Journal of General Practice 2018; 68 (suppl 1): bjgp18X696905. DOI: 10.3399/bjgp18X696905
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Print ISSN: 0960-1643
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