De beperkte detectie van longkanker op röntgenfoto's van de thorax

- In a study of everyday clinical practice, the diagnosis ‘lung cancer’ was not made on the chest X-ray initially in one-fifth of the cases, even though in retrospect the lesions had been visible on the chest X-ray. In nearly half of these cases, the diagnosis had been missed at least twice on succeeding X-rays of the patient in question.

- Most often, superimposed structures are responsible for having missed lesions on the chest X-ray; this was the case in 71 of the patients in whom a lesion was missed.

- The intra- and inter-observer variation in the detection of small tumours on the chest X-ray are quite large (κ: 0.38 and 0.48, respectively).

- Providing clinical information or previous chest X-rays for purposes of comparison does not improve the observer performance.

- Separate evaluation by two assessors (‘double reading’) also does not improve the results significantly.

- Simultaneous evaluation (‘dual reading’) improves the sensitivity slightly (from 28 to 37 ), but has hardly any effect on the specificity (from 93 to 92), thus improving the results somewhat.

- The results with computed tomography are much better (high sensitivity but low specificity). A CT-scan of the chest seems indicated in case of a suspicion of lung cancer and/or when there is a (slight) suspicion of lung cancer on the basis of the chest X-ray.