Detection of lung cancer on the chest radiograph: impact of previous films, clinical information, double reading, and dual reading

To study the impact of clinical information, previous chest radiographs, do uble reading (one pair of observers read the films independently) and dual reading (one pair of observers read the films simultaneously) on the sensit ivity, specificity and odds ratios of observers in the detection of early l ung cancer on the chest radiograph. The study was performed in 3 sessions. In the first session, 14 observers reviewed the chest radiographs of 100 ca ses (30 with early lung cancer, 35 with no abnormalities, 35 with other car diopulmonary diseases). Sensitivity, specificity, odds ratios and the effec t of double reading were calculated. After 4 months, a second session was h eld in which 7 oboservers reviewed all cases with the provision of all info rmation. The other 7 observers reviewed all cases without information again . To determine the effect of dual reading, in the third session, 4 pairs of observers reviewed all cases in which they disagreed in the first independ ent reading session. The effects of information, double reading and dual re ading on sensitivity, specificity and odds ratio were calculated. The sensi tivity of the observers in the first session ranged from 0.20 to 0.60 and t he specificity from 0.87 to 0.95. In the second session, these parameters c hanged only slightly, independent from the availability of clinical informa tion and previous films. With double reading the sensitivity increased and specificity decreased. With dual reading sensitivity increased and specific ity remained unchanged. The odds ratios were improved with double reading b y 4% and with the dual reading by 14%. Additional clinical information, pre vious chest radiographs, double reading and dual reading have little impact on the detection of early lung cancer on the chest radiograph. (C) 2001 El sevier Science Inc. All rights reserved.