ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2021
Estimating lung cancer risk from chest X-ray and symptoms: a prospective cohort study.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Pooled it
- AI-based chest X-ray prioritization in the lung cancer diagnostic pathway: the LungIMPACT randomized controlled trial.Nature medicine · 2026Trial
- Community pharmacy and lung cancer: a service innovation pilot using community pharmacy across Leeds to signpost patients with symptoms of possible lung cancers towards a patient self-request chest X-ray service.BMJ open respiratory research · 2026Article
- Evaluation of an Artificial Intelligence Defined Lung Nodule Malignancy Score in Incidental Pulmonary Nodules: The CREATE Study.Mayo Clinic proceedings. Digital health · 2026Article
- Diagnostic Delays in Thoracic Cancer Care: A Data-Linkage, Cohort Study between Primary Care, Hospital, and Registry Data.Health data science · 2026Article
- Systematic prioritisation of AI-detected chest X-ray abnormalities for optimised lung cancer detection.BJR artificial intelligence · 2026Review
- Diagnostic testing patterns for lung cancer-related symptoms in primary care: a retrospective cohort study.BMJ open respiratory research · 2025Article
- Changes in diagnostic evaluation of patients with lung cancer symptoms.NPJ primary care respiratory medicine · 2025Article
- Achieving earlier diagnosis of symptomatic lung cancer.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- The incidence of lung cancer amongst primary care chest radiograph referrals-an evaluation of national and local datasets within the United Kingdom.The British journal of radiology · 2024Article
- Etiology, diagnostic modalities, and short-term outcomes of hemoptysis-a retrospective cross-sectional study from a tertiary care center in Qatar.Journal of thoracic disease · 2023Article
- Improving early diagnosis of pancreatic cancer in symptomatic patients.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Article
- Overview and countermeasures of cancer burden in China.Science China. Life sciences · 2023Review
- Article
- Associations of chest X-ray trajectories, smoking, and the risk of lung cancer in two population-based cohort studies.Frontiers in oncology · 2023Article
- Current investigative modalities for detecting and staging lung cancers: a comprehensive summary.Indian journal of thoracic and cardiovascular surgery · 2023Review
- Trends and variation in urgent referrals for suspected cancer 2009/2010-2019/2020.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Article
- Chest X-Ray Images to Differentiate COVID-19 from Pneumonia with Artificial Intelligence Techniques.International journal of biomedical imaging · 2022Article
- Interpreting negative test results when assessing cancer risk in general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021Article
- Using Convoluted Neural Networks in Diagnosing Lung Cancer on Computed Tomography Scans.Current health sciences journalArticle
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChest X-ray (CXR) is the first-line investigation for lung cancer in many countries but previous research has suggested that the disease is not detected by CXR in approximately 20% of patients. The risk of lung cancer, with particular symptoms, following a negative CXR is not known.
aimTo establish the sensitivity and specificity of CXR requested by patients who are symptomatic; determine the positive predictive values (PPVs) of each presenting symptom of lung cancer following a negative CXR; and determine whether symptoms associated with lung cancer are different in those who had a positive CXR result compared with those who had a negative CXR result. DESIGN AND
settingA prospective cohort study was conducted in Leeds, UK, based on routinely collected data from a service that allowed patients with symptoms of lung cancer to request CXR.
methodSymptom data were combined with a diagnostic category (positive or negative) for each CXR, and the sensitivity and specificity of CXR for lung cancer were calculated. The PPV of lung cancer associated with each symptom or combination of symptoms was estimated for those patients with a negative CXR.
resultsIn total, 114 (1.3%) of 8996 patients who requested a CXR were diagnosed with lung cancer within 1 year. Sensitivity was 75.4% and specificity was 90.2%. The PPV of all symptoms for a diagnosis of lung cancer within 1 year of CXR was <1% for all individual symptoms except for haemoptysis, which had a PPV of 2.9%. PPVs for a diagnosis of lung cancer within 2 years of CXR was <1.5% for all single symptoms except for haemoptysis, which had a PPV of 3.9%.
conclusionCXR has limited sensitivity; however, in a population with a low prevalence of lung cancer, its high specificity and negative predictive value means that lung cancer is very unlikely to be present following a negative result. Findings also support guidance that unexplained haemoptysis warrants urgent referral, regardless of CXR result.
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