Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, BA1 3NG, UK.
Foundation Programme, Royal United Hospital Bath NHS Foundation Trust, Bath, UK.
Eur Radiol. 2021 Aug;31(8):6269-6274. doi: 10.1007/s00330-021-07708-0. Epub 2021 Jan 30.
The aim of this study was to analyse the use of the chest radiograph (CXR) as the first-line investigation in primary care patients with suspected lung cancer.
Of 16,945 primary care referral CXRs (June 2018 to May 2019), 1,488 were referred for suspected lung cancer. CXRs were coded as follows: CX1, normal but a CT scan is recommended to exclude malignancy; CX2, alternative diagnosis; or CX3, suspicious for cancer. Kaplan-Meier survival analysis was undertaken by stratifying patients according to their CX code.
In the study period, there were 101 lung cancer diagnoses via a primary care CXR pathway. Only 10% of patients with a normal CXR (CX1) underwent subsequent CT and there was a significant delay in lung cancer diagnosis in these patients (p < 0.001). Lung cancer was diagnosed at an advanced stage in 50% of CX1 patients, 38% of CX2 patients and 57% of CX3 patients (p = 0.26). There was no survival difference between CX codes (p = 0.42).
Chest radiography in the investigation of patients with suspected lung cancer may be harmful. This strategy may falsely reassure in the case of a normal CXR and prioritises resources to advanced disease.
• Half of all lung cancer diagnoses in a 1-year period are first investigated with a chest X-ray. • A normal chest X-ray report leads to a significant delay in the diagnosis of lung cancer. • The majority of patients with a normal or abnormal chest X-ray have advanced disease at diagnosis and there is no difference in survival outcomes based on the chest X-ray findings.
本研究旨在分析在疑似肺癌的初级保健患者中，将胸部 X 光（CXR）作为一线检查的使用情况。
在 16945 例初级保健转诊 CXR 中（2018 年 6 月至 2019 年 5 月），有 1488 例因疑似肺癌而转诊。CXR 编码如下：CX1，正常，但建议进行 CT 扫描以排除恶性肿瘤；CX2，其他诊断；或 CX3，可疑癌症。通过按 CX 代码分层患者，进行 Kaplan-Meier 生存分析。
在研究期间，通过初级保健 CXR 途径诊断出 101 例肺癌。仅有 10%的 CXR 正常（CX1）患者接受了后续 CT 检查，这些患者的肺癌诊断明显延迟（p < 0.001）。50%的 CX1 患者、38%的 CX2 患者和 57%的 CX3 患者被诊断为肺癌晚期（p = 0.26）。CX 代码之间的生存率无差异（p = 0.42）。
在疑似肺癌患者的检查中使用胸部 X 射线可能有害。这种策略可能会在 CXR 正常的情况下产生错误的保证，并优先考虑资源用于晚期疾病。
在 1 年期间，一半的肺癌诊断是通过胸部 X 射线首次进行调查的。
正常的胸部 X 射线报告导致肺癌诊断明显延迟。
大多数 CXR 正常或异常的患者在诊断时已处于晚期疾病，并且基于胸部 X 射线检查结果，生存率没有差异。
