Lung Cancers Missed on Chest Radiographs: Results Obtained with a Commercial Computer-aided Detection Program

Abstract

To retrospectively determine the sensitivity of and number of false-positive marks made by a commercially available computer-aided detection (CAD) system for identifying lung cancers previously missed on chest radiographs by radiologists, with histopathologic results as the reference standard. Institutional review board approval was obtained for this HIPAA-compliant study; the requirement for informed patient consent was waived. A CAD nodule detection program was applied to 34 posteroanterior digital chest radiographs obtained in 34 patients (21 men, 13 women; mean age, 69 years). All 34 radiographs showed a nodular lung cancer that was apparent in retrospect but had not been mentioned in the report. Two radiologists identified these radiologist-missed cancers on the chest radiographs and graded them for visibility, location, subtlety (extremely subtle to extremely obvious on a 10-point scale), and actionability (actionable or not actionable according to whether the radiologists probably would have recommended follow-up if the nodule had been detected). The CAD results were analyzed to determine the numbers of cancers and false-positive nodules marked and to correlate the CAD results with the nodule grades for subtlety and actionability. The chi2 test or Fisher exact test for independence was used to compare CAD sensitivity between the very subtle (grade 1-3) and relatively obvious (grade > 3) cancers and between the actionable and not actionable cancers. The CAD program had an overall sensitivity of 35% (12 of 34 cancers), identifying seven (30%) of 23 very subtle and five (45%) of 11 relatively obvious radiologist-missed cancers (P = .21) and detecting two (25%) of eight missed not actionable and ten (38%) of 26 missed actionable cancers (P = .33). The CAD program made an average of 5.9 false-positive marks per radiograph. The described CAD system can mark a substantial proportion of visually subtle lung cancers that are likely to be missed by radiologists.