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Missed Non–Small Cell Lung Cancer: Radiographic Findings of Potentially Resectable Lesions Evident Only in Retrospect¹

¹ From the Departments of Radiology at Columbia Presbyterian Center, New York-Presbyterian Hospital, 622 W 168th St, New York, NY 10032 (J.H.M.A., G.D.N.P., M.C.S., Y.M.B.); Weill Cornell Medical Center, New York-Presbyterian Hospital, NY (P.K.S.); University of Maryland Medical System, Baltimore (C.S.W., P.P.); and Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (L.B.H.). From the 2000 RSNA scientific assembly. Received November 26, 2001; revision requested February 8, 2002; revision received March 25; accepted April 29. Address correspondence to J.H.M.A. (e-mail: jha3@columbia.edu).

PURPOSE: To assess for change in the 1990s in the failure of detection at chest radiography of potentially resectable non–small cell lung cancer (NSCLC) lesions compared with experience in the previous decade.

MATERIALS AND METHODS: From 1993 to 2001, an observational cohort was identified that consisted of 40 instances of NSCLC evident retrospectively at chest radiography but undetected by a radiologist at a time when the cancer was potentially resectable for cure. Sizes and locations of the tumors were assessed. Pearson ² testing was performed to compare the sex distribution of lung cancer in the present series with population data for the sex distribution of lung cancer in the United States during the present study.

RESULTS: Twenty-five (62%) undetected NSCLCs were in men and 15 (38%) were in women, yielding a ratio not significantly different from that for the sex distribution of NSCLC according to national data (² = 0.22, P = .64). Median patient age was 62 years (range, 37–87 years). Median diameter of the missed cancers was 1.9 cm. Missed cancers were most commonly located in the upper lobes (right, 45%; left, 28%; total, 72%), especially in the apical and posterior segments/subsegments (60% of all the missed cancers). A clavicle obscured 22% of the missed cancers. Eighty-five percent of the missed cancers were in peripheral locations.

CONCLUSION: Potentially resectable NSCLC lesions missed at chest radiography were characterized by predominantly peripheral (85%) and upper lobe (72%) locations and by apical and posterior segmental/subsegmental locations in an upper lobe (60%). Distribution by sex of the missed cancers was comparable to national data for NSCLC. The missed cancers had a median diameter of 1.9 cm.

© RSNA, 2003

Index terms: Diagnostic radiology, observer performance • Lung neoplasms, 60.3211, 60.3212, 60.3214, 60.3216 • Lung neoplasms, diagnosis, 60.30

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