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
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.
Abbreviation: NSCLC = non-small cell lung cancer