Faculty Opinions recommendation of Minimal-dose computed tomography is superior to chest x-ray for the follow-up and treatment of patients with resected lung cancer.

The utility of chest x-ray examination (CXR) in mandatory annual health examinations for occupational health is debatable in Japan. This study aimed to provide basic data to consider future policies for mandatory annual health examinations in the workplace. A nationwide descriptive survey was performed to determine the rate of detection of tuberculosis, lung cancer, and other diseases through CXR in organizations associated with National Federation of Industrial Health Association. The rate of finding on CXR conducted during annual health examinations in FY2016 was evaluated. Data regarding diagnosis based on follow-up examination findings were obtained and compared with the national statistics. In addition, CXR findings were compared with the results of low-dose lung computed tomography performed at the Hitachi Health Care Center. From 121 surveyed institutions, 88 institutions with 8,669,403 workers were included. For all ages, 1.0% of examinees required follow-up examination. Among 4,764,985 workers with diagnosis data, the tuberculosis detection rate was 1.8–5.3 per 100,000 persons. For Lung cancer, 3,688,396 workers were surveyed, and 334 positive cases were detected. The lung cancer detection rate using CXR was 9.1–24.4 per 100,000 persons. From 164 cases with information regarding the clinical stage, 72 (43.9%) had Stage I lung cancer. From 40,045 workers who underwent low-dose computed tomography multiple times, 31 lung cancer cases, all with Stage I disease, were detected (detection rate: 77.4 per 100,000 persons). Our findings suggest that CXR plays a little role in the detection of active tuberculosis. With regard to LC screening, the detection rate of LC by CXR was lower, approximately 50%, than the expected rate (41.0 per 100,000 persons) of LC morbidity based on the age–sex distribution of this study population. However, the role of CXR for LC screening cannot be mentioned based on this result, because assessment of mortality reduction is essential to evaluate the role.

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Computed tomography follow-up identifies radically treatable new primaries after resection for lung cancer

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz284 ◽

2019 ◽

Cited By ~ 1

Author(s):

Jenny Mitchell ◽

Rachel Benamore ◽

Fergus Gleeson ◽

Elizabeth Belcher

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Early Stage ◽

Primary Lung Cancer ◽

Negative Likelihood Ratio ◽

University Hospitals ◽

Early Stage Lung Cancer ◽

X Ray ◽

Chest X Ray

Abstract OBJECTIVES The optimal imaging programme for the follow-up of patients who have undergone resection of primary lung cancer is yet to be determined. We investigated the incidence and patterns of new and recurrent malignancy after resection for early-stage lung cancer in patients enrolled into a computed tomography (CT) follow-up programme. METHODS We reviewed the outcomes of consecutive patients who underwent CT follow-up after resection of early-stage primary lung cancer at the Oxford University Hospitals NHS Foundation Trust, between 2013 and 2017. RESULTS Four hundred and sixty-six consecutive patients underwent resection of primary lung cancer between 1 January 2013 and 31 March 2017. Three hundred and thirty-one patients (71.0%) were enrolled in CT follow-up. The median follow-up was 98 weeks (range 26–262). Sixty patients (18.2%) were diagnosed with programme-detected malignancy. Recurrence was diagnosed in 36 patients (10.9%), new primary lung cancer in 16 patients (4.8%) and non-lung primary tumours in 8 patients (2.4%). A routine CT scan identified the majority of new primary lung cancers (84.2%) and those with disease recurrence (85.7%). The majority of programme-detected malignancies were radically treatable (55%). The median survival of programme-detected cancers was 92.4 versus 23.0 weeks for patients with clinically detected tumours (P < 0.0001). Utilizing the CT scout image as a surrogate for chest X-ray, the sensitivity of this modality was 16.95% (8.44–28.97%) and specificity was 89.83% (79.17–96.18%). Negative likelihood ratio was 0.92 (0.8–1.07). CONCLUSIONS CT follow-up of surgically treated primary lung cancer patients identifies malignancy at a stage where radical treatment is possible in the majority of patients. Chest X-ray follow-up may not be of benefit following lung cancer resection.

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Efficacy of chest X-ray in the diagnosis of COVID-19 pneumonia: comparison with computed tomography through a simplified scoring system designed for triage

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00541-x ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Akın Çinkooğlu ◽

Selen Bayraktaroğlu ◽

Naim Ceylan ◽

Recep Savaş

Keyword(s):

Computed Tomography ◽

Intensive Care ◽

Intensive Care Units ◽

Scoring System ◽

Imaging Modality ◽

Ground Glass Opacity ◽

Initial Presentation ◽

X Ray ◽

Chest X Ray

Abstract Background There is no consensus on the imaging modality to be used in the diagnosis and management of Coronavirus disease 2019 (COVID-19) pneumonia. The purpose of this study was to make a comparison between computed tomography (CT) and chest X-ray (CXR) through a scoring system that can be beneficial to the clinicians in making the triage of patients diagnosed with COVID-19 pneumonia at their initial presentation to the hospital. Results Patients with a negative CXR (30.1%) had significantly lower computed tomography score (CTS) (p < 0.001). Among the lung zones where the only infiltration pattern was ground glass opacity (GGO) on CT images, the ratio of abnormality seen on CXRs was 21.6%. The cut-off value of X-ray score (XRS) to distinguish the patients who needed intensive care at follow-up (n = 12) was 6 (AUC = 0.933, 95% CI = 0.886–0.979, 100% sensitivity, 81% specificity). Conclusions Computed tomography is more effective in the diagnosis of COVID-19 pneumonia at the initial presentation due to the ease detection of GGOs. However, a baseline CXR taken after admission to the hospital can be valuable in predicting patients to be monitored in the intensive care units.

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Differential diagnosis of hemoptysis

Spravočnik vrača obŝej praktiki (Journal of Family Medicine) ◽

10.33920/med-10-2106-06 ◽

2021 ◽

pp. 47-55

Author(s):

Petr Arkadievich Ilyin

Keyword(s):

Infectious Disease ◽

Computed Tomography ◽

Lung Cancer ◽

Differential Diagnosis ◽

Correct Interpretation ◽

Diagnostic Investigation ◽

Detailed History ◽

X Ray ◽

Chest X Ray ◽

Upper Gastrointestinal

Blood expectoration or hemoptysis is the coughing up of sputum with blood from the larynx, bronchi or lungs. Hemoptysis is most often caused by diseases of the respiratory tract and lungs — bronchitis or pneumonia, as well as lung cancer, aspergilloma, tuberculosis, bronchiectasis, pulmonary embolism, etc. In the diagnostic investigation of the cause of hemoptysis, it is important to take a detailed history (in the case of an epidemiological history, a laboratory analysis of the secreted sputum for the detection of the causative agent of an infectious disease is necessary), to make the correct interpretation of the patient’s complaints and an assessment of the nature of the sputum (differential diagnosis with bleeding from the upper gastrointestinal tract). A chest X-ray is performed and, then, if indicated, computed tomography, bronchoscopy, and other studies are made. The article presents an algorithm for differential diagnostic investigation of hemoptysis in a patient

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Health and quality of life (QOL) issues in four groups of lung cancer patients: Low-dose computed tomography (LDCT) screened, chest x-ray detected, incidentally found, and routinely diagnosed.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.1610 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 1610-1610

Author(s):

Ping Yang ◽

Kathleen J. Yost ◽

Matthew M. Clark ◽

Mariza de Andrade ◽

Katherine M. Piderman ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cancer Patients ◽

Low Dose ◽

Incidental Finding ◽

X Ray ◽

Lung Cancer Patients ◽

Patient Reported ◽

Chest X Ray ◽

Low Dose Computed Tomography

1610 Background: Low dose computed tomography (LDCT) scans have reduced lung cancer deaths by 20.3% in high risk populations, although there is an unknown balance between the benefits and harms of LDCT scans as a screening tool. Our purpose was to compare health-related QOL issues among lung cancer patients who were initially detected by LDCT scans; 4 comparison groups included: lung cancer diagnosed by a screening chest X-ray, as an incidental finding from procedures taken for other medical reasons, or based on symptoms indicative for lung cancer and routinely diagnosed, and individuals who were LDCT screened but found no lung cancer (controls who participated in Mayo’s lung cancer CT screening trial). Methods: A total of 1,658 lung cancer patients (cared at Mayo Clinic) in the 4 groups (37, 151, 389, and 1081 respectively) and 488 controls were compared on following patient-reported outcomes (collected via validated tools): overall QOL, four symptoms (cough, pain, dyspnea, fatigue), mental/ physical/ emotional/ social/ spiritual QOL, and other concerns (e.g., family/ friends/ financial/ legal). A clinically significant deficit was defined as at least 10-points in difference (or <50 points) on a 0-100 scale. The rates of deficits were compared via Fisher’s exact tests and average QOL values via Kruskal-Wallis tests. Results: Overall QOL and individual symptoms were significantly worse (p<0.05) in all lung cancer groups than in controls, except for pain. LDCT-screened patients reported the greatest deficit among the 4 lung cancer groups in physical (41%), emotional (24%), social (38%), and spiritual QOL (24%); whereas chest X-ray detected patients had the least deficit in overall QOL (22%) and pain (32%). All 4 lung cancer groups experienced much worse fatigue (52-64%) than the controls (32%). Conclusions: Our preliminary results suggest that LDCT-screening detected lung cancer patients reported a different QOL profile from other lung cancer patients and non-lung cancer controls. The clinical course, smoking behavior, and QOL related health issues associated with LDCT screening for lung cancer warrant thorough investigation.

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Postoperative follow-up of lung cancer: Randomized trial comparing two follow-up programs in completely resected non-small cell lung cancer (IFCT-0302).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.tps7111 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. TPS7111-TPS7111

Author(s):

Virginie Westeel ◽

Fabrice Barlesi ◽

Jean Domas ◽

Philippe Girard ◽

Pascal Foucher ◽

...

Keyword(s):

Lung Cancer ◽

Physical Examination ◽

Ct Scan ◽

Fiberoptic Bronchoscopy ◽

Chest Ct ◽

Small Cell Lung ◽

X Ray ◽

Chest X Ray ◽

Chest Ct Scan

TPS7111 Background: There are no robust data published on the follow-up after surgery for non-small cell lung cancer (NSCLC). Current international guidelines are informed by expert opinion. Most of them recommend regular follow-up with clinic visit and thoracic imaging, either chest X-ray of Chest CT-scan. The IFCT-0302 trial addresses the question whether a surveillance program with chest CT-scan and fiberoptic bronchoscopy can improve survival compared to a follow-up only based on physical examination and chest x-ray. There is no such trial ongoing over the world. Methods: The IFCT-0302 trial is a multicenter open-label controlled randomized phase III trial. The objective of the trial is to compare two follow-up programs after surgery for stage I-IIIa NSCLC. The primary endpoint is overall survival. Patients are randomly assigned to arm 1, minimal follow-up, including physical examination and chest x-ray; or arm 2, a follow-up consisting of physical examination and chest x-ray plus chest CT scan and fiberoptic bronchoscopy (optional for adenocarcinomas). In both arms, follow-up procedures are performed every 6 months during the first two postoperative years, and every year between the third and the fifth years. The main eligibility criteria include: completely resected stage I-IIIA (6th UICC TNM classification) or T4 (in case of nodules in the same lobe as the tumor) N0 M0 NSCLC, surgery within the previous 8 weeks. Patients who have received and/or who will receive pre/post-operative chemotherapy and/or radiotherapy are eligible. Statistical considerations: 1,744 patients is required. Accrual status: 1,568 patients from 119 French centers had been included. The end of accrual can be expected for September 2012. Ancillary study: Blood samples are collected in 1000 patients for genomic high density SNP micro-array analysis. This collection will contribute to the French genome wide association study (gwas) of lung cancer gene susceptibility, and the genetic factors predictive of survival and lung cancer recurrence will be analyzed.

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Comparative effectiveness of lung cancer screening by computed tomography (CT) vs. chest x-ray (CXR) vs. no screening.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.e18246 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. e18246-e18246

Author(s):

John Paul Flores ◽

Alejandro Moreno-Koehler ◽

Matthew Finkelman ◽

Jaime Caro ◽

Gary M. Strauss

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Comparative Effectiveness ◽

Lung Cancer Screening ◽

X Ray ◽

Chest X Ray

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Characteristics and Predictors of Missed Opportunities in Lung Cancer Diagnosis: An Electronic Health Record–Based Study

Journal of Clinical Oncology ◽

10.1200/jco.2009.25.6636 ◽

2010 ◽

Vol 28 (20) ◽

pp. 3307-3315 ◽

Cited By ~ 69

Author(s):

Hardeep Singh ◽

Kamal Hirani ◽

Himabindu Kadiyala ◽

Olga Rudomiotov ◽

Traber Davis ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Diagnosis ◽

Type I ◽

Type Ii ◽

Missed Opportunities ◽

X Ray ◽

Lung Cancer Diagnosis ◽

Abnormal Chest ◽

Chest X Ray

Purpose Understanding delays in cancer diagnosis requires detailed information about timely recognition and follow-up of signs and symptoms. This information has been difficult to ascertain from paper-based records. We used an integrated electronic health record (EHR) to identify characteristics and predictors of missed opportunities for earlier diagnosis of lung cancer. Methods Using a retrospective cohort design, we evaluated 587 patients of primary lung cancer at two tertiary care facilities. Two physicians independently reviewed each case, and disagreements were resolved by consensus. Type I missed opportunities were defined as failure to recognize predefined clinical clues (ie, no documented follow-up) within 7 days. Type II missed opportunities were defined as failure to complete a requested follow-up action within 30 days. Results Reviewers identified missed opportunities in 222 (37.8%) of 587 patients. Median time to diagnosis in cases with and without missed opportunities was 132 days and 19 days, respectively (P < .001). Abnormal chest x-ray was the clue most frequently associated with type I missed opportunities (62%). Follow-up on abnormal chest x-ray (odds ratio [OR], 2.07; 95% CI, 1.04 to 4.13) and completion of first needle biopsy (OR, 3.02; 95% CI, 1.76 to 5.18) were associated with type II missed opportunities. Patient adherence contributed to 44% of patients with missed opportunities. Conclusion Preventable delays in lung cancer diagnosis arose mostly from failure to recognize documented abnormal imaging results and failure to complete key diagnostic procedures in a timely manner. Potential solutions include EHR-based strategies to improve recognition of abnormal imaging and track patients with suspected cancers.

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A Successful Resection of Two Giant Mediastinal Neurogenic Tumors

Polish Journal of Surgery ◽

10.1515/pjs-2015-0007 ◽

2015 ◽

Vol 86 (12) ◽

Author(s):

Daniel Brzeziński ◽

Mariusz łochowski ◽

Józef Kozak

Keyword(s):

Computed Tomography ◽

Pleural Cavity ◽

Middle Age ◽

Postoperative Treatment ◽

X Ray ◽

Neurogenic Tumors ◽

Chest X Ray

AbstractWe reported two cases of the giant mediastinal neurogenic tumors. Patients were women in middle age. In both cases the chest X-ray and CT (computed tomography) demonstrated the huge mass in a pleural cavity without intraspinal invasion. Radical procedures with removal of the giant tumors were performed. The postoperative treatment course was uneventful. The pathology showed schwannoma and neurofibroma. The follow up examination (6-24 months) showed no recurrence of the disease.

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