chest Xray (CXR) and diagnostic accuracy for lung cancer

Last edited 06/2020 and last reviewed 07/2022

Chest Xray and Diagnostic Accuracy for Lung Cancer

  • chest radiography is used almost as an extended clinical assessment of patients presenting with chest symptoms. Lung cancer is one of the most common malignancies but there are no specific symptoms or signs that reliably differentiate it from a non neoplastic chest pathology

  • literature reveals a range of missed lung cancer rates from 20% to 60% on chest radiography (1-7)

    • in one published report with respect to "missed lung cancers" on chest radiography
      • 90% of peripheral lesions and 75% of peri-hilar lesions were visible on retrospective review at a centre of excellence (8)

    • a systematic review revealed that approximately 25% of lung cancers were "missed" on chest Xray (9)


  • 1. Quekel LG, Goei R, Kessels AG, et al. Limited detection of lung cancer on chest X-rays. Ned Tijdschr Geneeskd, 2003;31;147:1048-56.
  • 2. Schofield TD, Youngberg RA. CXR interpretation and lung cancer: experience at Madigan Army Medical Centre. Mil Med, 1993;158:297-9.
  • 3. Quekel LG, Kessels AG, Goei R, et al. Miss rate of lung cancer on the chest radiograph in clinical practice. Chest, 1999;115:720-4.
  • 4. Sone S, Li F, Yang ZG, et al. Characteristics of small lung cancers invisible on conventional CXR and detected by population based screening using spiral CT. Br J Radiol, 2000;73:137-45.
  • 5. Wilde J Jr. Wilde J Sr. Ganguin HG. Current roentgenologic delay in bronchial carcinoma. Zeitschrift fur Erkrankungen der Atmungsorgane, 1983;160:107-27.
  • 6. Monnier-Cholley L, Arrive L, Porcel A, et al. Characteristics of missed lung cancer on chest radiographs: a French experience. Eur Radiol, 2001;11:597-605.
  • 7. Shah PK, Austin JH, White CS, Zak M et al. Missed non-small cell lung cancer: radiographic findings of potentially resectable lesions evident only in retrospect. Radiology, 2003;226:235-41.
  • 8. Jett JR & Midthun DE. Screening for Lung Cancer: Current Status and Future Direction. Thomas A Neff Lecture. Chest 2004; 125: 1585-1625.
  • 9. Bradley S et al. Sensitivity of chest X-ray for lung cancer: systematic review.Br J Gen Pract 2018; 68 (suppl 1)