Detection of lung cancer on the chest radiograph: impact of previous films, clinical information, double reading, and dual reading.

To study the impact of clinical information, previous chest radiographs, double reading (one pair of observers read the films independently) and dual reading (one pair of observers read the films simultaneously) on the sensitivity, specificity and odds ratios of observers in the detection of early lung cancer on the chest radiograph. The study was performed in 3 sessions. In the first session, 14 observers reviewed the chest radiographs of 100 cases (30 with early lung cancer, 35 with no abnormalities, 35 with other cardiopulmonary diseases). Sensitivity, specificity, odds ratios and the effect of double reading were calculated. After 4 months, a second session was held in which 7 observers reviewed all cases with the provision of all information. The other 7 observers reviewed all cases without information again. To determine the effect of dual reading, in the third session, 4 pairs of observers reviewed all cases in which they disagreed in the first independent reading session. The effects of information, double reading and dual reading on sensitivity, specificity and odds ratio were calculated. The sensitivity of the observers in the first session ranged from 0.20 to 0.60 and the specificity from 0.87 to 0.95. In the second session, these parameters changed only slightly, independent from the availability of clinical information and previous films. With double reading the sensitivity increased and specificity decreased. With dual reading sensitivity increased and specificity remained unchanged. The odds ratios were improved with double reading by 4% and with the dual reading by 14%. Additional clinical information, previous chest radiographs, double reading and dual reading have little impact on the detection of early lung cancer on the chest radiograph.

Miss rate of lung cancer on the chest radiograph in clinical practice.

STUDY OBJECTIVES: To investigate the miss rate of non-small cell lung cancer (NSCLC) on the chest radiograph. In addition, the characteristics, the delay in diagnosis, and the change in prognosis of the missed lesions were studied. DESIGN: A retrospective study on patients with histopathologically proven NSCLC during the years 1992 through 1995 in a large community hospital. SETTING: Department of Radiology, Atrium Medical Center, Heerlen, the Netherlands. PATIENTS: During the study period, 495 patients presented with NSCLC. Of these patients, the complete set of chest radiographs was available for analysis in 396; there were 300 men and 96 women, with a mean age of 68 years. MAIN OUTCOME MEASURES: The main outcome measures included the miss rate of NSCLC presenting as nodular lesions. Location, diameter, superposing structures, and delay of missed and detected lesions and the change of prognosis as a consequence of the delay in diagnosis were other measures. RESULTS: In 49 (19%) of 259 patients with NSCLC presenting as a nodular lesion on the chest radiographs, the lesions were missed. The miss rate was not dependent on location. Superposing structures were more often present in the group of missed lesions than in the group of detected lesions, respectively, 71% and 2%. The median diameter of the missed lesions was 16 mm and of the detected lesions it was 40 mm. The median delay of the missed lesions was 472 days and of the detected lesions it was 29 days. Twenty-two (45%) patients with missed lesions remained in stage T1, 6 (12%) remained in stage T2 and in 21 patients (43%), the tumor stage changed from stage T1 into T2. CONCLUSION: The miss rate of 19% in our study is low compared with the rate in the literature but it has a definitive impact on prognosis.

Detection of lung cancer on the chest radiograph: a study on observer performance.

STUDY OBJECTIVES: to study the validity and observers consistency in the detection of lung cancer on the chest radiograph. MATERIALS AND METHODS: the chest radiographs of 100 clinical cases were interpreted by 14 observers. The radiographs were obtained from 30 patients with initially missed but histopathologically proven non-small cell lung cancer (NSCLC), 35 patients with other cardiopulmonary diseases and 35 patients with no abnormalities. The observers consisted of ten experienced radiologists, two-experienced chest physicians and two residents in radiology. All observers were unaware of the study design. The validity and observer consistency was determined for each observer. RESULTS: the mean sensitivity and specificity of the ten radiologists were 0.36 and 0.90. For the two chest physicians, the mean sensitivity and specificity were 0.29 and 0.96. For the two residents in radiology, mean sensitivity and specificity were 0.25 and 0.94. The mean interobserver kappa and mean intraobserver kappa for the radiologists were 0.38 and 0.54. For the two chest physicians, the mean interobserver kappa was 0.43, while the intraobserver kappa was 0.59. For the two residents in radiology, mean interobserver kappa was 0.35 and the intraobserver kappa was 0.42. There was no significant relation between the consistency parameters and validity parameters. The interobserver and intraobserver kappa values showed good correlation. CONCLUSION: the validity of the chest radiograph and observers consistency in the detection of nodular lung cancer varies widely. The level of experience is likely to influence the diagnostic performance.

[The value of skull and cervical spine radiography in patients following blunt head injury]. / Het nut van schedel- en halswervelkolomfoto's bij patiënten na stomp hoofdletsel.

In a consecutive series of 100 patients with blunt head trauma the efficacy of routine skull and cervical radiography was studied. Neurocranial and facial skeletal lesions were present in 8 patients, only 1 skull fracture being completely unsuspected clinically. In all 79 patients without cervical signs or symptoms the cervical spine films were within normal limits. Only two of the 21 patients with some form of local cervical spine symptomatology presented with traumatic changes. In 19 patients the cervical spine films did not demonstrate the cervicothoracic junction to satisfaction. Although this study confirms the low yield of routine conventional radiography in patients with blunt head trauma, the authors state that optimal conventional examination of the cervical spine is mandatory in all patients with blunt head trauma and the slightest suspicion of cervical symptoms or complaints and in those patients in whom either clinical examination or the clinical history is not completely satisfactory. The cervicothoracic junction should be adequately visualised. A CT or MRI scan of the brain should be preferred over conventional skull films in those patients in whom examination of the skull is considered indicated.

[The limited detection of lung cancer on chest X-rays]. / 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 (kappa: 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.

The influence of wire localisation for non-palpable breast lesions on visualisation of the sentinel node.

PURPOSE: In our clinic, patients with occult breast lesions are treated with a sentinel node biopsy combined with wire-guided tumour excision. The aim of this retrospective study was to determine the influence of the sequence of wire localisation and sentinel node procedure on visualisation of the sentinel node. METHODS: A total of 136 patients had a wire-guided tumour excision combined with a sentinel node procedure. Sixty-six patients had guide wire localisation prior to the sentinel node procedure. Seventy patients had sentinel node visualisation before insertion of the guide wire. RESULTS: The sentinel node was visualised in 41 (62%) of the patients who first underwent guide wire localisation. In the group of patients who underwent visualisation of the sentinel node before placement of the guide wire, the sentinel node was visualised in 62 (89%). This is a significant difference in visualisation (p<0.001). CONCLUSION: This study shows that guide wire localisation prior to the sentinel node procedure negatively influences visualisation of the sentinel node.

The "dural tail sign" in MRI of spinal meningiomas.

OBJECTIVE: Evaluation of "dural tail sign" in spinal meningiomas with gadolinium enhanced MRI in sagittal, axial, and especially coronal planes. MATERIALS AND METHODS: On a 0.5 T system, sagittal and axial T1 spin echo images (TR/TE 550/22) and sagittal T2 turbo spin echo images (TR/TE 2855/150) of the thoracolumbar spine were acquired. After administration of gadolinium (0.1 mmol/kg), sagittal, axial, and coronal T1 spin echo images (TR/TE 500/30) were acquired at the area of the tumors. RESULTS: The nonenhanced images demonstrated intradural and extramedullary tumors with a signal intensity in the T1 images a little higher than the adjacent spinal cord. After the administration of gadolinium, homogeneous enhancement of the tumors was seen. An even stronger enhancement was noticed at the borders of the tumors with the adjacent meninges, seen in the sagittal, axial, and even better in the coronal views. Both tumors proved histologically to be meningiomas. CONCLUSION: In evaluating spinal meningiomas, a gadolinium enhanced MRI of the spine in sagittal, axial, and especially coronal planes should be performed to detect "dural tails," very suggestive of meningioma. These three scanning planes are necessary to visualize the localization and extent of the tumors and their tails prior to surgery.