Chest
Volume 115, Issue 3, March 1999, Pages 720-724
Journal home page for Chest

Clinical Investigations
Lung Cancer
Miss Rate of Lung Cancer on the Chest Radiograph in Clinical Practice

https://doi.org/10.1378/chest.115.3.720Get rights and content

Study objectives

To investigate the miss rate of non-small cell lung cancer (NSCLC) on the chest radiograph. In addition, the characteristics, the delay in diagnosis, and the change in prognosis of the missed lesions were studied.

Design

A retrospective study on patients with histopathologically proven NSCLC during the years 1992 through 1995 in a large community hospital.

Setting

Department of Radiology, Atrium Medical Center, Heerlen, the Netherlands.

Patients

During the study period, 495 patients presented with NSCLC. Of these patients, the complete set of chest radiographs was available for analysis in 396; there were 300 men and 96 women, with a mean age of 68 years.

Main outcome measures

The main outcome measures included the miss rate of NSCLC presenting as nodular lesions. Location, diameter, superposing structures, and delay of missed and detected lesions and the change of prognosis as a consequence of the delay in diagnosis were other measures.

Results

In 49 (19%) of 259 patients with NSCLC presenting as a nodular lesion on the chest radiographs, the lesions were missed. The miss rate was not dependent on location. Superposing structures were more often present in the group of missed lesions than in the group of detected lesions, respectively, 71% and 2%. The median diameter of the missed lesions was 16 mm and of the detected lesions it was 40 mm. The median delay of the missed lesions was 472 days and of the detected lesions it was 29 days. Twenty-two (45%) patients with missed lesions remained in stage T1, 6 (12%) remained in stage T2 and in 21 patients (43%), the tumor stage changed from stage T1 into T2.

Conclusion

The miss rate of 19% in our study is low compared with the rate in the literature but it has a definitive impact on prognosis.

Section snippets

Materials and Methods

The study included all consecutive patients with pathologically proven NSCLC selected from the database of the Dutch National Pathologic Anatomic Cancer Registration System between 1992 and 1995 in a 700-bed community hospital. Patients with recurrent cancer after therapy were excluded. The chest radiographs were obtained in the 125- to 150-kVp range, grid ratio 12:1, focus film distance 150 cm, rare earth screen with speed class 400 (Agfa ortho regular or Agfa curix HT-U films; Agfa Gevaert;

Results

From the Dutch National Pathologic Anatomic Cancer Registration System database, 495 consecutive patients from 1992 through 1995 with histopathologic proven first detected NSCLCs were identified in our hospital. In 99 patients, the radiographs were not traceable.

The characteristics of the remaining 396 patients are presented in Table 1. In 36 patients, more than one abnormality on the chest radiograph was visible.

Two radiologists preselected 259 patients with visible lesions on the chest

Discussion

To our knowledge, no studies have been reported that addressed the miss rate of the chest radiography in detecting lung cancer in clinical practice. In the literature, the miss rate of such lesions varied between 25% and 90%,10,11,12,13 but as indicated in the introduction, these figures originate from studies that differ largely in objective and design. In our study, a miss rate of 19% was found.

In 99 of the 495 cases, a chest radiograph was not available for analysis. However, there was no

References (24)

  • L Berlin

    Malpractice and radiologists, update 1986: 11.5 year perspective

    AJR Am J Roentgenol

    (1986)
  • AK Kenneth

    Medicolegal analysis of the delayed diagnosis of cancer: 338 cases in the United States

    Arch Churg

    (1994)
  • EJ Potchen et al.

    When is it malpractice to miss lung cancer on chest radiographs?

    Radiology

    (1990)
  • JH Woodring

    Pitfalls in the radiologic diagnosis of lung cancer

    AJR Am J Roentgenol

    (1990)
  • BG Brogdon et al.

    Factors affecting perception of pulmonary lesions

    Radiol Clin North Am

    (1988)
  • JA Sorenson et al.

    Effects of improved contrast on lung-nodule detection: a clinical ROC study

    Invest Radiol

    (1987)
  • CA Kelsey et al.

    Effect of size and position on chest lesion detection

    AJR Am J Roentgenol

    (1977)
  • JHM Austin et al.

    Missed bronchogenic carcinoma: radiographic findings in 27 patients with a potentially resectable lesion evident in retrospect

    Radiology

    (1992)
  • JV Forrest et al.

    Radiologic errors in patients with lung cancer

    West J Med

    (1981)
  • FP Stitik et al.

    Radiographic screening in the early detection of lung cancer

    Radiol Clin North Am

    (1978)
  • RT Heelan et al.

    Non-small-cell lung cancer: results of the New York screening program

    Radiology

    (1984)
  • JR Muhm et al.

    Lung cancer detected during a screening program using 4-month chest radiographs

    Radiology

    (1983)
  • Cited by (0)

    View full text