PT - JOURNAL ARTICLE AU - Stephen H Bradley AU - Sarah Abraham AU - Matthew EJ Callister AU - Adam Grice AU - William T Hamilton AU - Rocio Rodriguez Lopez AU - Bethany Shinkins AU - Richard D Neal TI - Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review AID - 10.3399/bjgp19X706853 DP - 2019 Dec 01 TA - British Journal of General Practice PG - e827--e835 VI - 69 IP - 689 4099 - http://bjgp.org/content/69/689/e827.short 4100 - http://bjgp.org/content/69/689/e827.full SO - Br J Gen Pract2019 Dec 01; 69 AB - 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.