Chest X-ray is insufficient to rule out lung cancer in patients with symptoms, and GPs should consider further investigation in high-risk patients who have had a negative chest X-ray. That is the finding of a systematic review published in the British Journal of General Practice this week.
The research led by the University of Leeds identified 21 eligible studies from a search of MEDLINE, EMBASE and the Cochrane Library, as well as a grey literature search.
While the quality of most of the evidence was considered to be poor, data drawn from the highest quality research suggested sub-optimal sensitivity for chest X-ray to identify lung cancer.
Most articles were case studies with a high risk of bias. Only one study had the diagnostic accuracy of chest X-ray as its primary objective. Several were drawn from non-representative groups, for example, specific presentations, histological sub-types or co-morbidities. Three studies had a low risk of bias.
Two primary care studies reported sensitivities of 76.8 per cent (95% CI, 64.5%-84.2%) and 79.3 per cent (95% CI, 67.6%-91.0%). One secondary care study reported a sensitivity of 79.7 per cent (95% CI, 72.7%-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 per cent to 80 per cent. GPs should consider if further investigation is necessary in high-risk patients who have had a negative chest X-ray,” the authors advise.