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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).

View larger version (134K): [in a new window]   Figure 1a. (a) Posteroanterior (PA) chest radiograph of a missed adenocarcinoma (arrow) with an estimated long axis length of 1.6 cm in the upper lobe of the left lung of a 55-year-old man. The cancer is obscured by two ribs. (b) A focal opacity (arrow) is visible and was detected on this PA chest radiograph, which was obtained 16 months after a. (c) CT scan obtained at the same time as b reveals a 4-cm mass (arrow). Missed cancers were located in the upper lobe in 72% of the patients in the present series.

View larger version (128K): [in a new window]   Figure 1b. (a) Posteroanterior (PA) chest radiograph of a missed adenocarcinoma (arrow) with an estimated long axis length of 1.6 cm in the upper lobe of the left lung of a 55-year-old man. The cancer is obscured by two ribs. (b) A focal opacity (arrow) is visible and was detected on this PA chest radiograph, which was obtained 16 months after a. (c) CT scan obtained at the same time as b reveals a 4-cm mass (arrow). Missed cancers were located in the upper lobe in 72% of the patients in the present series.

View larger version (97K): [in a new window]   Figure 1c. (a) Posteroanterior (PA) chest radiograph of a missed adenocarcinoma (arrow) with an estimated long axis length of 1.6 cm in the upper lobe of the left lung of a 55-year-old man. The cancer is obscured by two ribs. (b) A focal opacity (arrow) is visible and was detected on this PA chest radiograph, which was obtained 16 months after a. (c) CT scan obtained at the same time as b reveals a 4-cm mass (arrow). Missed cancers were located in the upper lobe in 72% of the patients in the present series.

View larger version (140K): [in a new window]   Figure 2a. (a) PA chest radiograph of a missed undifferentiated carcinoma (arrow) with an estimated long axis length of 2.8 cm in the superior aspect of the hilum of the right lung of a 37-year-old man with human immunodeficiency virus. (b) PA chest radiograph obtained five months after a shows that the cancer (arrow) has enlarged. The cancer was detected on this radiograph. In the present series, 45% of the missed cancers occurred in the upper lobe of the right lung, and 42% of missed cancers were 2.0 cm or larger.

View larger version (140K): [in a new window]   Figure 2b. (a) PA chest radiograph of a missed undifferentiated carcinoma (arrow) with an estimated long axis length of 2.8 cm in the superior aspect of the hilum of the right lung of a 37-year-old man with human immunodeficiency virus. (b) PA chest radiograph obtained five months after a shows that the cancer (arrow) has enlarged. The cancer was detected on this radiograph. In the present series, 45% of the missed cancers occurred in the upper lobe of the right lung, and 42% of missed cancers were 2.0 cm or larger.

View larger version (139K): [in a new window]   Figure 3. PA chest radiograph of a missed adenocarcinoma (arrow) with an estimated long axis length of 2.0 cm in the posterior basal segment of the lower lobe of the right lung of a 70-year-old man. The primary location of 85% of the missed cancers in the present series was in the periphery of the lung.