The British Journal of Radiology, Vol 73, Issue 866 137-145, Copyright © 2000 by British Institute of Radiology

ARTICLES

Characteristics of small lung cancers invisible on conventional chest radiography and detected by population based screening using spiral CT

S Sone, F Li, ZG Yang, S Takashima, Y Maruyama, M Hasegawa, JC Wang, S Kawakami and T Honda
Department of Radiology, Shinshu University School of Medicine, Nagano, Japan.

Conventional chest radiography (CXR) is a poor diagnostic tool for detecting lung cancers at a surgically curable stage. To determine the visibility of peripheral small lung cancers on CXR, we retrospectively examined the usefulness of CXR using a consecutive series of 44 cases detected on CT screening and later confirmed by histopathology. All cases had been detected by low dose CT during a population based screening trial for lung cancer. The control group consisted of 48 chest radiographs of normal subjects. Tumour diameters ranged from 6 mm to 45 mm, with 95% (42/44) < or = 20 mm, and 5% (2/44) > 20 mm. CXR failed to detect 77% (34/44) of all cancers, including 79% (33/42) < or = 20 mm and 50% (1/2) > 20 mm. Of the 42 lung cancers < or = 20 mm, 74% (31/42) were located in the well penetrated lung zones and 71% (22/31) of these were missed on CXR. 26% (11/42) were concealed by hilar vessels, mediastinum, heart or diaphragm, and all (11/11) of these were missed on CXR. 93% (39/42) of the lung cancers < or = 20 mm were adenocarcinomas and 79% (31/39) of these were missed on CXR. 7% (3/42) were epidermoid carcinomas or small cell carcinomas and 66% (2/3) of these were missed on CXR. The overall accuracy of interpretation on CXR for lung cancers was 61%, sensitivity was 23% and specificity 96%. Although there was an association between presence of lung cancer and positive reading of CXR (chi 2 test of association, p < 0.05), the percentage of positive readings was only 23%. Thus, CXR was poor at visualizing CT detectable lung cancers of < or = 20 mm diameter, which are usually of very low density, and cannot be relied upon for detection of surgically curable small lung cancer.

This article has been cited by other articles:

				M Bellomi, G Veronesi, C Rampinelli, S Ferretti, E De Fiori, and P Maisonneuve Evolution of lung nodules <=5 mm detected with low-dose CT in asymptomatic smokers Br. J. Radiol., September 1, 2007; 80(957): 708 - 712. [Abstract] [Full Text] [PDF]

				C. Black, R. de Verteuil, S. Walker, J. Ayres, A. Boland, A. Bagust, and N. Waugh Population screening for lung cancer using computed tomography, is there evidence of clinical effectiveness? A systematic review of the literature Thorax, February 1, 2007; 62(2): 131 - 138. [Abstract] [Full Text] [PDF]

				M. B. Lobrano Partnerships in Oncology and Radiology: The Role of Radiology in the Detection, Staging, and Follow-up of Lung Cancer Oncologist, July 1, 2006; 11(7): 774 - 779. [Abstract] [Full Text] [PDF]

				K. Awai, K. Murao, A. Ozawa, Y. Nakayama, T. Nakaura, D. Liu, K. Kawanaka, Y. Funama, S. Morishita, and Y. Yamashita Pulmonary Nodules: Estimation of Malignancy at Thin-Section Helical CT--Effect of Computer-aided Diagnosis on Performance of Radiologists Radiology, April 1, 2006; 239(1): 276 - 284. [Abstract] [Full Text] [PDF]

				K Ono, T Yoshitake, K Akahane, Y Yamada, T Maeda, M Kai, and T Kusama Comparison of a digital flat-panel versus screen-film, photofluorography and storage-phosphor systems by detection of simulated lung adenocarcinoma lesions using hard copy images Br. J. Radiol., October 1, 2005; 78(934): 922 - 927. [Abstract] [Full Text] [PDF]

				S. G. Spiro and G. A. Silvestri One Hundred Years of Lung Cancer Am. J. Respir. Crit. Care Med., September 1, 2005; 172(5): 523 - 529. [Abstract] [Full Text] [PDF]

				J. R. Jett Limitations of Screening for Lung Cancer with Low-Dose Spiral Computed Tomography Clin. Cancer Res., July 1, 2005; 11(13): 4988s - 4992s. [Abstract] [Full Text] [PDF]

				W. D. Travis, K. Garg, W. A. Franklin, I. I. Wistuba, B. Sabloff, M. Noguchi, R. Kakinuma, M. Zakowski, M. Ginsberg, R. Padera, et al. Evolving Concepts in the Pathology and Computed Tomography Imaging of Lung Adenocarcinoma and Bronchioloalveolar Carcinoma J. Clin. Oncol., May 10, 2005; 23(14): 3279 - 3287. [Abstract] [Full Text] [PDF]

				S. J. Swensen, J. R. Jett, T. E. Hartman, D. E. Midthun, S. J. Mandrekar, S. L. Hillman, A.-M. Sykes, G. L. Aughenbaugh, A. O. Bungum, and K. L. Allen CT Screening for Lung Cancer: Five-year Prospective Experience Radiology, April 1, 2005; 235(1): 259 - 265. [Abstract] [Full Text] [PDF]

				B. E. Chapman, D. F. Yankelevitz, C. I. Henschke, and D. Gur Lung Cancer Screening: Simulations of Effects of Imperfect Detection on Temporal Dynamics Radiology, February 1, 2005; 234(2): 582 - 590. [Abstract] [Full Text] [PDF]

				K Doi Current status and future potential of computer-aided diagnosis in medical imaging Br. J. Radiol., January 1, 2005; 78(suppl_1): S3 - s19. [Abstract] [Full Text] [PDF]

				J. R. Jett and D. E. Midthun Screening for Lung Cancer: Current Status and Future Directions: Thomas A. Neff Lecture Chest, May 1, 2004; 125(5_suppl): 158S - 162S. [Abstract] [Full Text] [PDF]

				R MacRedmond, P M Logan, M Lee, D Kenny, C Foley, and R W Costello Screening for lung cancer using low dose CT scanning Thorax, March 1, 2004; 59(3): 237 - 241. [Abstract] [Full Text] [PDF]

				K. Awai, K. Murao, A. Ozawa, M. Komi, H. Hayakawa, S. Hori, and Y. Nishimura Pulmonary Nodules at Chest CT: Effect of Computer-aided Diagnosis on Radiologists' Detection Performance Radiology, February 1, 2004; 230(2): 347 - 352. [Abstract] [Full Text] [PDF]

				A. McWilliams, J. Mayo, S. MacDonald, J. C. leRiche, B. Palcic, E. Szabo, and S. Lam Lung Cancer Screening: A Different Paradigm Am. J. Respir. Crit. Care Med., November 15, 2003; 168(10): 1167 - 1173. [Abstract] [Full Text] [PDF]

				S. J Swensen Computed tomography screening for cancer BMJ, October 6, 2003; 327(7418): E207 - 207. [Full Text] [PDF]

				B. J. Hillman CT Screening: Who Benefits and Who Pays Radiology, July 1, 2003; 228(1): 26 - 28. [Full Text] [PDF]

				S. J. Swensen, J. R. Jett, T. E. Hartman, D. E. Midthun, J. A. Sloan, A.-M. Sykes, G. L. Aughenbaugh, and M. A. Clemens Lung Cancer Screening with CT: Mayo Clinic Experience Radiology, March 1, 2003; 226(3): 756 - 761. [Abstract] [Full Text] [PDF]

				P. K. Shah, J. H. M. Austin, C. S. White, P. Patel, L. B. Haramati, G. D. N. Pearson, M. C. Shiau, and Y. M. Berkmen Missed Non-Small Cell Lung Cancer: Radiographic Findings of Potentially Resectable Lesions Evident Only in Retrospect Radiology, January 1, 2003; 226(1): 235 - 241. [Abstract] [Full Text] [PDF]

				F. Li, S. Sone, H. Abe, H. MacMahon, S. G. Armato III, and K. Doi Lung Cancers Missed at Low-Dose Helical CT Screening in a General Population: Comparison of Clinical, Histopathologic, and Imaging Findings Radiology, December 1, 2002; 225(3): 673 - 683. [Abstract] [Full Text] [PDF]

				S. J. Swensen CT Screening for Lung Cancer Am. J. Roentgenol., October 1, 2002; 179(4): 833 - 836. [Full Text] [PDF]

				S. J. SWENSEN, J. R. JETT, J. A. SLOAN, D. E. MIDTHUN, T. E. HARTMAN, A.-M. SYKES, G. L. AUGHENBAUGH, F. E. ZINK, S. L. HILLMAN, G. R. NOETZEL, et al. Screening for Lung Cancer with Low-Dose Spiral Computed Tomography Am. J. Respir. Crit. Care Med., February 15, 2002; 165(4): 508 - 513. [Abstract] [Full Text] [PDF]

				R.J. van Klaveren, J.D.F. Habbema, J.H. Pedersen, H.J. de Koning, M. Oudkerk, and H.C. Hoogsteden Lung cancer screening by low-dose spiral computed tomography Eur. Respir. J., November 1, 2001; 18(5): 857 - 866. [Abstract] [Full Text] [PDF]

				C. Brambilla and S. Spiro Highlights in lung cancer Eur. Respir. J., October 1, 2001; 18(4): 617 - 618. [Full Text] [PDF]

				Z.-G. Yang, S. Sone, S. Takashima, F. Li, T. Honda, Y. Maruyama, M. Hasegawa, and S. Kawakami High-Resolution CT Analysis of Small Peripheral Lung Adenocarcinomas Revealed on Screening Helical CT Am. J. Roentgenol., June 1, 2001; 176(6): 1399 - 1407. [Abstract] [Full Text] [PDF]

				J. R. Jett Spiral Computed Tomography Screening for Lung Cancer Is Ready for Prime Time Am. J. Respir. Crit. Care Med., March 15, 2001; 163(4): 812 - 813. [Full Text]