Miss rate of lung cancer on the chest radiograph in clinical practice

Study objectives: To investigate the miss rate of non-small cell lung cance r (NSCLC) on the chest radiograph. In addition, the characteristics, the de lay in diagnosis, and the change in prognosis of the missed lesions were st udied. Design: A retrospective study on patients with histopathologically proven N SCLC during the years 1992 through 1995 in a large community hospital. Setting: Department of Radiology, Atrium Medical Center, Heerlen, the Nethe rlands. Patients: During the study period, 495 patients presented with NSCLC. Of th ese patients, the complete set of chest radiographs was available for analy sis 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 struct ures, and delay of missed and detected lesions and the change of prognosis as a consequence of the delay diagnosis were other measures. Results: In 49 (19%) of 259 patients with NSCLC presenting as a nodular les ion on the chest radiographs, the lesions were missed. The miss rate was no t dependent on location. Superposing structures were more often present in the group of missed lesions than in the group of detected lesions, respecti vely, 71% and 2%. The median diameter of the missed lesions was 16 mm and o f the detected lesions it nas 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 stag e T2 and in 21 patients (43%), the tumor stage changed from stage T1 into T 2. 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.