CHEST X-RAY AND THE DIAGNOSIS OF LUNG CANCER

 

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It is easier to say what a chest-x-ray is not than what it is.  It is not a reliable tool for detecting lung cancer, or distinguishing lung cancer from other disease.  Estimates vary but some suggest as many as 20-25% of x-rays are misread. 

A. Structure and Problems With the X-Ray

Radiologists are called upon to make critical assessments based upon what are frequently almost imperceptible shadows. The chest contains tissues of different consistency, with air next to thick soft tissue and bone. Adequately producing an image which provides clear definition of all structures in the chest requires meticulous technique and attention to detail. The machine (film processor) used to develop the film should be working properly though up to 50% of x-ray film processors may have some deficiency. (1)


While this is the most commonly performed examination, it often is done incorrectly. Studies have shown that from 2040% of x-rays are incorrectly interpreted. (1) Indeed, there is a discernible difference in skill among radiologists interpreting chest x-ray films. However, even with good equipment and skilled people, the x-ray is still inaccurate.

B. Problem in Interpreting Small Lesions

An important 1999 study discussed deficiencies in the chest x-ray, contrasting it with the accuracy of the CT or Cat Scan. In this study 1,000 smokers with no symptoms of disease were evaluated with CT Scan and chest x-ray. 27 of the participants were found to have lung tumors which were detected by CT Scan. However, only 7 of the 27 tumors were detected by chest x-ray.   Many corporations trumpet less than 1 in 100 defects for various products and the HLA test for detecting paternity is more than 99.7% accurate. The chest x-ray in contrast was shown here to be less than 30% accurate in the patients who would benefit most by early diagnosis.

C. Preference for CT Scan

In contrast to the X-ray's interpretative problems and inherent limitations, the CT Scan provides an excellent tool for identify tumors, and distinguishing them from other disease. If there is any doubt, a CT Scan should be taken, at least in our opinion.

An even more sensitive test is the combined CT Scan and Pet Scan, which identifies tumors based upon their visual appearance and chemical makeup as shown by PET Scan. 


References

1. Hentschke, Early Lung Cancer Action Project: Baseline Screening, Lancet, 1999, 354, 99-105.

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Over 70% of lung tumors are diagnosed at advanced stages, reducing the patient's opportunity for long term survival.   In some instances, a doctor's failure to promptly diagnose a lung tumor, and order or interpret appropriate tests may be malpractice.  Our office handles failure to diagnose lung cancer cases in New Jersey and New York.    

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Howard A. Gutman, 973-598-1980 
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