HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shah, P. K. Articles by Berkmen, Y. M. Search for Related Content PubMed PubMed Citation Articles by Shah, P. K. Articles by Berkmen, Y. M.

Missed Non–Small Cell Lung Cancer: Radiographic Findings of Potentially Resectable Lesions Evident Only in Retrospect¹

¹ From the Departments of Radiology at Columbia Presbyterian Center, New York-Presbyterian Hospital, 622 W 168th St, New York, NY 10032 (J.H.M.A., G.D.N.P., M.C.S., Y.M.B.); Weill Cornell Medical Center, New York-Presbyterian Hospital, NY (P.K.S.); University of Maryland Medical System, Baltimore (C.S.W., P.P.); and Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (L.B.H.). From the 2000 RSNA scientific assembly. Received November 26, 2001; revision requested February 8, 2002; revision received March 25; accepted April 29. Address correspondence to J.H.M.A. (e-mail: jha3@columbia.edu).

PURPOSE: To assess for change in the 1990s in the failure of detection at chest radiography of potentially resectable non–small cell lung cancer (NSCLC) lesions compared with experience in the previous decade.

MATERIALS AND METHODS: From 1993 to 2001, an observational cohort was identified that consisted of 40 instances of NSCLC evident retrospectively at chest radiography but undetected by a radiologist at a time when the cancer was potentially resectable for cure. Sizes and locations of the tumors were assessed. Pearson ² testing was performed to compare the sex distribution of lung cancer in the present series with population data for the sex distribution of lung cancer in the United States during the present study.

RESULTS: Twenty-five (62%) undetected NSCLCs were in men and 15 (38%) were in women, yielding a ratio not significantly different from that for the sex distribution of NSCLC according to national data (² = 0.22, P = .64). Median patient age was 62 years (range, 37–87 years). Median diameter of the missed cancers was 1.9 cm. Missed cancers were most commonly located in the upper lobes (right, 45%; left, 28%; total, 72%), especially in the apical and posterior segments/subsegments (60% of all the missed cancers). A clavicle obscured 22% of the missed cancers. Eighty-five percent of the missed cancers were in peripheral locations.

CONCLUSION: Potentially resectable NSCLC lesions missed at chest radiography were characterized by predominantly peripheral (85%) and upper lobe (72%) locations and by apical and posterior segmental/subsegmental locations in an upper lobe (60%). Distribution by sex of the missed cancers was comparable to national data for NSCLC. The missed cancers had a median diameter of 1.9 cm.

© RSNA, 2003

Index terms: Diagnostic radiology, observer performance • Lung neoplasms, 60.3211, 60.3212, 60.3214, 60.3216 • Lung neoplasms, diagnosis, 60.30

This article has been cited by other articles:

				F. Girvin and J. P. Ko Pulmonary Nodules: Detection, Assessment, and CAD Am. J. Roentgenol., October 1, 2008; 191(4): 1057 - 1069. [Abstract] [Full Text] [PDF]

				F. Li, R. Engelmann, K. Doi, and H. MacMahon Improved Detection of Small Lung Cancers with Dual-Energy Subtraction Chest Radiography Am. J. Roentgenol., April 1, 2008; 190(4): 886 - 891. [Abstract] [Full Text] [PDF]

				F. Li, R. Engelmann, C. E. Metz, K. Doi, and H. MacMahon Lung Cancers Missed on Chest Radiographs: Results Obtained with a Commercial Computer-aided Detection Program Radiology, January 1, 2008; 246(1): 273 - 280. [Abstract] [Full Text] [PDF]

				H. Singh, S. Sethi, M. Raber, and L. A. Petersen Errors in Cancer Diagnosis: Current Understanding and Future Directions J. Clin. Oncol., November 1, 2007; 25(31): 5009 - 5018. [Abstract] [Full Text] [PDF]

				M. K. Gould, J. Fletcher, M. D. Iannettoni, W. R. Lynch, D. E. Midthun, D. P. Naidich, and D. E. Ost Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 108S - 130S. [Abstract] [Full Text] [PDF]

				M. Das, G. Muhlenbruch, A. H. Mahnken, T. G. Flohr, L. Gundel, S. Stanzel, T. Kraus, R. W. Gunther, and J. E. Wildberger Small Pulmonary Nodules: Effect of Two Computer-aided Detection Systems on Radiologist Performance. Radiology, November 1, 2006; 241(2): 564 - 571. [Abstract] [Full Text] [PDF]

				K. Peldschus, P. Herzog, S. A. Wood, J. I. Cheema, P. Costello, and U. J. Schoepf Computer-Aided Diagnosis as a Second Reader: Spectrum of Findings in CT Studies of the Chest Interpreted as Normal Chest, September 1, 2005; 128(3): 1517 - 1523. [Abstract] [Full Text] [PDF]

				L. Monnier-Cholley, F. Carrat, B. P. Cholley, J.-M. Tubiana, and L. Arrive Detection of Lung Cancer on Radiographs: Receiver Operating Characteristic Analyses of Radiologists', Pulmonologists', and Anesthesiologists' Performance Radiology, December 1, 2004; 233(3): 799 - 805. [Abstract] [Full Text] [PDF]

				S. Tigges, D. L. Roberts, K. H. Vydareny, and D. A. Schulman Routine Chest Radiography in a Primary Care Setting Radiology, November 1, 2004; 233(2): 575 - 578. [Abstract] [Full Text] [PDF]