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

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. To estimat...

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Bibliographic Details
Published in:British journal of general practice 2019-12, Vol.69 (689), p.e827-e835
Main Authors: Bradley, Stephen H, Abraham, Sarah, Callister, Matthew Ej, Grice, Adam, Hamilton, William T, Lopez, Rocio Rodriguez, Shinkins, Bethany, Neal, Richard D
Format: Article
Language:English
Subjects:
Accuracy
Lung cancer
Medical diagnosis
Sensitivity analysis
Systematic review
Thorax
X-rays
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Summary: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. To estimate the sensitivity of chest X-ray for detecting lung cancer in symptomatic people. A systematic review was conducted to determine the sensitivity of chest X-ray for the detection of lung cancer. Databases including MEDLINE, EMBASE, and the Cochrane Library were searched; a grey literature search was also performed. 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%). 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.
ISSN:0960-1643
1478-5242
DOI:10.3399/bjgp19X706853