@article {Bradleybjgp19X706853, author = {Stephen H Bradley and Sarah Abraham and Matthew EJ Callister and Adam Grice and William T Hamilton and Rocio Rodriguez Lopez and Bethany Shinkins and Richard D Neal}, title = {Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review}, elocation-id = {bjgp19X706853}, year = {2019}, doi = {10.3399/bjgp19X706853}, publisher = {Royal College of General Practitioners}, abstract = {Background Despite increasing use of computed tomography (CT), chest X-ray remains the first-line investigation for suspected lung cancer in primary care in the UK. No systematic review evidence exists as to the sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms.Aim To estimate the sensitivity of chest X-ray for detecting lung cancer in symptomatic people.Design and setting A systematic review was conducted to determine the sensitivity of chest X-ray for the detection of lung cancer.Method Databases including MEDLINE, EMBASE, and the Cochrane Library were searched; a grey literature search was also performed.Results A total of 21 studies met the eligibility criteria. Almost all were of poor quality. Only one study had the diagnostic accuracy of chest X-ray as its primary objective. Most articles were case studies with a high risk of bias. Several were drawn from non-representative groups, for example, specific presentations, histological subtypes, or comorbidities. Only three studies had a low risk of bias. Two primary care studies reported sensitivities of 76.8\% (95\% confidence interval [CI] = 64.5 to 84.2\%) and 79.3\% (95\% CI = 67.6 to 91.0\%). One secondary care study reported a sensitivity of 79.7\% (95\% CI = 72.7 to 86.8\%).Conclusion Though there is a paucity of evidence, the highest-quality studies suggest that the sensitivity of chest X-ray for symptomatic lung cancer is only 77\% to 80\%. GPs should consider if further investigation is necessary in high-risk patients who have had a negative chest X-ray.}, issn = {0960-1643}, URL = {https://bjgp.org/content/early/2019/10/21/bjgp19X706853}, eprint = {https://bjgp.org/content/early/2019/10/21/bjgp19X706853.full.pdf}, journal = {British Journal of General Practice} }