What is the role of chest radiography in the workup of secondary lung tumors?

Updated: Feb 16, 2021
  • Author: Daniel S Schwartz, MD, MBA, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Chest radiography using high-quality posteroanterior and lateral radiographs remains the most common imaging study in the initial staging evaluation of lung cancer patients. However, because of poor yield, it is rarely recommended as a part of the initial workup for common cancers (eg, breast cancer and colon cancer) at an early stage.

This is reflected by the observation that lung metastases have been detected with radiography in only 0.1% of the patients with stage I breast cancer. Chest radiographs are limited by the potential to overlook lesions located in the lung apices or posterior sulci or against the heart or mediastinum and by their overall poor sensitivity for lung nodules of less than 1.6 cm in diameter (far lower sensitivity than that of CT).

Overall, approximately 25% of the total lung volume is not readily accessible for visual examination with plain posteroanterior chest radiography.

However, recognition of secondary pulmonary tumors has increased with advances in this modality. Improvements in technique, including the use of Advanced Multiple Beam Equalization Radiography (AMBER) and a digital slot-scan charge-coupled device (CCD) system, have increased the utility of this simple and inexpensive staging modality.

Kroft et al showed that AMBER and CCD digital film systems were equivalent in detecting phantom nodules in or around the mediastinum (135/288 [46.9%] and 128/288 [44.4%], respectively). Both of these technologies were superior to older Bucky screen film technology (65/288 [22.6%]). [9]

However, other studies, using chest CT as the criterion standard, failed to confirm that these techniques had a significant advantage over standard chest radiographs. [10]

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