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. 2023 Feb 28;15(2):928-939.
doi: 10.21037/jtd-22-111. Epub 2023 Feb 7.

Diagnostic yield of chest radiograph in management of adults with difficult-to-treat chronic cough-retrospective study

Olga Truba  1 , Marta Dabrowska  1 , Elzbieta M Grabczak  1 , Katarzyna Bialek-Gosk  1 , Aleksandra Rybka-Fraczek  1 , Karolina Klimowicz  1 , Malgorzata Zukowska  2 , Rafal Krenke  1
Affiliations

Diagnostic yield of chest radiograph in management of adults with difficult-to-treat chronic cough-retrospective study

Olga Truba et al. J Thorac Dis. .

Abstract

Background: Chest radiograph (CXR) is a routine imaging test in adults with chronic cough (CC), while value of thoracic computed tomography (CT) in these patients is still a matter of discussion. The aims of the study were to assess the diagnostic yield of CXR and to evaluate the impact of thoracic CT on management of patients with difficult-to-treat CC referred to our cough clinic.

Methods: The retrospective analysis of paired CXR and CT results was performed in 189 consecutive adults treated due to CC between 2015-2019 in our cough clinic. CC was defined as cough >8 weeks being the main or isolated ailment. The sensitivity, specificity, negative/positive predictive value (NPV, PPV) and diagnostic accuracy of CXR were calculated based on chest CT scan as the "gold standard". Only those CT scans which revealed abnormalities potentially related to CC and were associated with the changes in further diagnostic or therapeutic approach were construed as relevant CT findings during final analysis.

Results: The median age of patients (male/female ratio 53/136) was 58 years (IQR 44-67), only 6 subjects (3.0%) were active smokers, median CC duration was 48 months (IQR 24-120). CXR revealed abnormal findings in 23/189 (12.2%) patients. Normal CXR was confirmed by CT in 141 subjects (141/166; 84.9%). In 25/166 (15.1%) patients, CT showed abnormalities that could explain the cause of CC and changed either the diagnostic protocol or therapy. In patients with abnormal CXR, CT confirmed abnormal findings in 8 cases (8/23, 34.8%). The sensitivity, specificity, PPV, NPV, diagnostic accuracy were 24.2%, 90.4%, 34.8%, 84.9% and 78.8%, respectively.

Conclusions: CXR shows a limited diagnostic yield in adults with difficult-to-treat CC referred to cough clinic. Chest CT scan may add significant data impacting the diagnostic and therapeutic approach in these patients.

Keywords: Chest radiograph (CXR); chronic cough (CC); computed tomography (CT); diagnostic accuracy; diagnostic yield.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-111/coif). MD has received fees from Merck for consultations and lectures on chronic cough, outside the submitted work. EMG has received honorary for lectures on chronic cough from Merck and Polpharma, outside the submitted work. ARF has received fee from Polpharma for attendance at ERS International Congress (2019), outside the submitted work. RK reports research grant from the National Science Centre, Poland, honoraria for lectures from Chiesi, AstraZeneca, Polpharma and MSD, fees for Advisory Board participation from MSD and AstraZeneca; all the above outside the submitted work. Boehringer Ingelheim, Chiesi, AstraZeneca and MSD have covered his fee and travel expenses for international conferences, outside the submitted work. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart presenting patient selection for the study. CXR, chest radiograph; CC, chronic cough; CT, computed tomography.
Figure 2
Figure 2
Distribution of CXR and CT results. CXR, chest radiograph; CT, computed tomography.
Figure 3
Figure 3
Distribution of patients with negative result of CXR. CXR, chest radiograph.
Figure 4
Figure 4
Distribution of patients with a positive result of CXR. CXR, chest radiograph.
Figure 5
Figure 5
ROC curve for diagnostic accuracy of negative CXR in relations to age of patients with chronic cough. ROC, received operating characteristic; CXR, chest radiograph.
See this image and copyright information in PMC

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