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. 2019 Nov 28;69(689):e827-e835.
doi: 10.3399/bjgp19X706853. Print 2019 Dec.

Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review

Stephen H Bradley  1 , Sarah Abraham  2 , Matthew Ej Callister  3 , Adam Grice  1 , William T Hamilton  4 , Rocio Rodriguez Lopez  5 , Bethany Shinkins  5 , Richard D Neal  1
Affiliations

Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review

Stephen H Bradley et al. Br J Gen Pract. .

Abstract

Background: Despite increasing use of computed tomography (CT), chest X-ray remains the first-line investigation for suspected lung cancer in primary care in the UK. No systematic review evidence exists as to the sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms.

Aim: To estimate the sensitivity of chest X-ray for detecting lung cancer in symptomatic people.

Design and setting: A systematic review was conducted to determine the sensitivity of chest X-ray for the detection of lung cancer.

Method: Databases including MEDLINE, EMBASE, and the Cochrane Library were searched; a grey literature search was also performed.

Results: A total of 21 studies met the eligibility criteria. Almost all were of poor quality. Only one study had the diagnostic accuracy of chest X-ray as its primary objective. Most articles were case studies with a high risk of bias. Several were drawn from non-representative groups, for example, specific presentations, histological subtypes, or comorbidities. Only three studies had a low risk of bias. Two primary care studies reported sensitivities of 76.8% (95% confidence interval [CI] = 64.5 to 84.2%) and 79.3% (95% CI = 67.6 to 91.0%). One secondary care study reported a sensitivity of 79.7% (95% CI = 72.7 to 86.8%).

Conclusion: Though there is a paucity of evidence, the highest-quality studies suggest that the sensitivity of chest X-ray for symptomatic lung cancer is only 77% to 80%. GPs should consider if further investigation is necessary in high-risk patients who have had a negative chest X-ray.

Keywords: X-rays; diagnostic imaging; early diagnosis; lung cancer; primary care.

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Figure 1.
Figure 1.
PRISMA diagram of study inclusion.
See this image and copyright information in PMC

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