Accuracy of clinical diagnosis of lung cancer in Budapest in an institute specializing in chest diseases

Among 250 consecutive autopsies (170 males and 80 females) performed at the Institute of Pulmonology in Budapest in 1996/7, there were 132 deaths in w hich cancer of the lung/bronchus was deemed to be the underlying cause of d eath. At autopsy, six cases previously thought to be dying from lung cancer were found to have died from other diseases (false positive rate = 5%). Tw elve lung cancer deaths were also found to have been missed, a false negati ve rate of 9%, which was similar for adenocarcinoma, squamous carcinoma, an d small cell carcinoma cases. Our findings confirmed the expectation expres sed earlier [1] that death certification of lung cancer would be more accur ate in an institute specializing in chest diseases, to which patients had t o be fit enough to be transferred, than in two general hospitals in Budapes t. Nevertheless, since most cases certified as dying from lung cancer die w ithout the benefits available in the specialized institute, the estimated f alse negative and positive rates for lung cancer death certification in Hun gary remain high, at an estimated 56% and 30%, respectively. The much lower autopsy rates in most other countries than in Hungary points to there bein g considerable inaccuracy in lung cancer mortality rates internationally.