Potential of Chest Radiography in Primary Diagnosis of Lung Cancer

Abstract

Objective: to evaluate the effectiveness of diagnostics for non-small cell lung cancer (LC) based on chest radiography/fluorography data for LC screening diagnostics during preventive medical examination and check-ups.Material and methods. The work was organized as a retrospective cohort study. The starting point of the study was chest radiography, the final point was the diagnosis of LC based on the results of low-dose computed tomography (LDCT) and tumor morphological examination. The patient sample was composed using inclusion and exclusion criteria and initially included 800 patients, then narrowed down to 788. Patients were divided into groups according to LC stage and depending on whether radiography during preventive measures made it possible to suspect LC verified within 3 months via LDCT for any reasons not related to the suspicion of a tumor process. The diagnostic coefficient and informative value of radiography were calculated for each stage of the established LC diagnosis.Results. The study showed that chest radiography does not allow establishing stage I LC diagnosis (J=0.00; p<0.05), it is low informative for stage II LC (J=0.25; p<0.05), and medium informative for stage III LC (J=0.80; p<0.05). Chest radiography does not reliably detect LC signs at early stages in 84.3% of cases.Conclusion. The obtained results indicate an insufficient sensitivity of radiography as a screening method, primarily for early LC diagnosis. The introduction of chest LDCT instead of radiography into the procedure for preventive medical examination and check-ups of the adult population approved by the Ministry of Health of the Russian Federation will increase LC detection at early stages by 5.37 times (95% confidence interval 3,77–7,64).