BACKGROUND: The main investigation for suspected lung cancer in primary care is a chest X-ray. Reports from secondary care show that some patients with normal chest X-rays transpire to have lung cancer. The assumption is that this occurs rarely in primary care. AIM: The aim of this study was to examine the frequency of misleading chest X-rays in primary care, and whether there were any particular symptoms associated with them. DESIGN OF STUDY: Retrospective cohort study of the primary care records of 247 lung cancer patients diagnosed between 1998-2002. SETTING: All general practices in Exeter Primary Care Trust, Devon, UK. METHOD: All chest X-rays and all common symptoms of lung cancer reported to primary care were identified from the medical records. X-ray results were categorised into three groups by the radiologist's report: normal; abnormal but no malignancy suspected (together classified as negative X-rays); or abnormal with possible malignancy. RESULTS: Of the 247 patients, 164 (66%) had a chest X-ray taken in primary care during the year before diagnosis: 126 of these (77%) were abnormal with possible malignancy; 21 (13%) were abnormal but with no malignancy suspected; in 17 (10%) the X-ray was reported as normal. Thus, 38 of 164 patients (23%; 95% confidence interval = 16 to 32%) had a negative X-ray. Negative X-rays were less common in the 90 days before diagnosis. No particular symptoms were significantly associated with negative X-rays. CONCLUSION: Nearly a quarter of chest X-rays requested from primary care in lung cancer patients are negative. Further investigation is warranted with continuing or changing symptoms, even if the X-ray is not suggestive of malignancy.
BACKGROUND: The main investigation for suspected lung cancer in primary care is a chest X-ray. Reports from secondary care show that some patients with normal chest X-rays transpire to have lung cancer. The assumption is that this occurs rarely in primary care. AIM: The aim of this study was to examine the frequency of misleading chest X-rays in primary care, and whether there were any particular symptoms associated with them. DESIGN OF STUDY: Retrospective cohort study of the primary care records of 247 lung cancerpatients diagnosed between 1998-2002. SETTING: All general practices in Exeter Primary Care Trust, Devon, UK. METHOD: All chest X-rays and all common symptoms of lung cancer reported to primary care were identified from the medical records. X-ray results were categorised into three groups by the radiologist's report: normal; abnormal but no malignancy suspected (together classified as negative X-rays); or abnormal with possible malignancy. RESULTS: Of the 247 patients, 164 (66%) had a chest X-ray taken in primary care during the year before diagnosis: 126 of these (77%) were abnormal with possible malignancy; 21 (13%) were abnormal but with no malignancy suspected; in 17 (10%) the X-ray was reported as normal. Thus, 38 of 164 patients (23%; 95% confidence interval = 16 to 32%) had a negative X-ray. Negative X-rays were less common in the 90 days before diagnosis. No particular symptoms were significantly associated with negative X-rays. CONCLUSION: Nearly a quarter of chest X-rays requested from primary care in lung cancerpatients are negative. Further investigation is warranted with continuing or changing symptoms, even if the X-ray is not suggestive of malignancy.
Authors: M Elisabeth Del Giudice; Sheila-Mae Young; Emily T Vella; Marla Ash; Praveen Bansal; Andrew Robinson; Roland Skrastins; Yee Ung; Robert Zeldin; Cheryl Levitt Journal: Can Fam Physician Date: 2014-08 Impact factor: 3.275
Authors: Stephen H Bradley; Sarah Abraham; Matthew Ej Callister; Adam Grice; William T Hamilton; Rocio Rodriguez Lopez; Bethany Shinkins; Richard D Neal Journal: Br J Gen Pract Date: 2019-11-28 Impact factor: 5.386
Authors: Robert W Foley; Vanessa Nassour; Helen C Oliver; Toby Hall; Vidan Masani; Graham Robinson; Jonathan C L Rodrigues; Benjamin J Hudson Journal: Eur Radiol Date: 2021-01-30 Impact factor: 5.315