Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Missed Lung Cancers on Chest Radiograph: An Illustrative Review of Common Blind Spots on Chest Radiograph with Emphasis on Various Radiologic Presentations of Lung Cancers

놓치기 쉬운 폐암: 흉부 X선 진단의 함정에 대한 이해와 다양한 폐암 영상 소견의 중요성

  • Goun Choi (Department of Radiology, Soonchunhyang University Hospital) ;
  • Bo Da Nam (Department of Radiology, Soonchunhyang University Hospital) ;
  • Jung Hwa Hwang (Department of Radiology, Soonchunhyang University Hospital) ;
  • Ki-Up Kim (Department of Respiratory and Allergy Medicine, Soonchunhyang University Hospital) ;
  • Hyun Jo Kim (Department of Cardiothoracic Surgery, Soonchunhyang University Hospital) ;
  • Dong Won Kim (Department of Pathology, Soonchunhyang University Hospital)
  • 최고운 (순천향대학교병원 영상의학과) ;
  • 남보다 (순천향대학교병원 영상의학과) ;
  • 황정화 (순천향대학교병원 영상의학과) ;
  • 김기업 (순천향대학교병원 호흡기알레르기내과) ;
  • 김현조 (순천향대학교병원 흉부외과) ;
  • 김동원 (순천향대학교병원 병리과)
  • Received : 2019.07.05
  • Accepted : 2019.08.24
  • Published : 2020.03.01
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Abstract

Missed lung cancers on chest radiograph (CXR) may delay the diagnosis and affect the prognosis. CXR is the primary imaging modality to evaluate the lungs and mediastinum in daily practice. The purpose of this article is to review chest radiographs for common blind spots and highlight the importance of various radiologic presentations in primary lung cancer to avoid significant diagnostic errors on CXR.

흉부 X선은 폐와 종격동 질환을 평가하는 데 있어 매우 중요한 일차 영상 검사이다. 초기 흉부 X선에서 놓친 폐암은 환자의 진단을 지연시키고 예후에 중요한 영향을 줄 수 있다. 저자들은 초기 흉부 X선에서 폐암의 중요한 진단적 오류를 피하기 위하여 비교적 흔히 접하게 되는 영상 진단의 함정에 대하여 다양한 증례를 통하여 검토하고 또한 폐암의 다양한 영상 소견의 중요성에 대하여 중점적으로 살펴보고자 한다.

Keywords

References

  1. Gibbs JM, Chandrasekhar CA, Ferguson EC, Oldham SA. Lines and stripes: where did they go?--From conventional radiography to CT. Radiographics 2007;27:33-48 
  2. Ellis SM, Flower C. The WHO manual of diagnostic imaging: radiographic anatomy and interpretation of the chest and the pulmonary system. Geneva: World Health Organization 2006 
  3. Quekel LG, Kessels AG, Goei R, Van Engelshoven JM. Miss rate of lung cancer on the chest radiograph in clinical practice. Chest 1999;115:720-724 
  4. Turkington PM, Kennan N, Greenstone MA. Misinterpretation of the chest x ray as a factor in the delayed diagnosis of lung cancer. Postgrade Med J 2002;78:158-160 
  5. Del Ciello A, Franchi P, Contegiacomo A, Cicchetti G, Bonomo L, Larici AR. Missed lung cancer: when, where, and why? Diagn Interv Radiol 2017;23:118-126 
  6. Kashiwabara K, Koshi S, Ota K, Tanaka M, Toyonaga M. Outcome in patients with lung cancer found retrospectively to have had evidence of disease on past lung cancer mass screening roentgenograms. Lung Cancer 2002;35:237-241 
  7. Woodring J. Pitfalls in the radiologic diagnosis of lung cancer. AJR Am J Roentgenol 1990;154:1165-1175 
  8. Qin C, Yao D, Shi Y, Song Z. Computer-aided detection in chest radiography based on artificial intelligence: a survey. Biomed Eng Online 2018;17:113 
  9. Lakhani P, Sundaram B. Deep learning at chest radiography: automated classification of pulmonary tuberculosis by using convolutional neural networks. Radiology 2017;284:574-582 
  10. Hwang EJ, Park S, Jin KN, Kim JI, Choi SY, Lee JH, et al. Development and validation of a deep learning- based automated detection algorithm for major thoracic diseases on chest radiographs. JAMA Netw Open 2019;2:e191095 
  11. Shah PK, Austin JH, White CS, Patel P, Haramati LB, Pearson GD, et al. Missed non-small cell lung cancer: radiographic findings of potentially resectable lesions evident only in retrospect. Radiology 2003;226:235-241 
  12. McLoud TC, Isler RJ, Novelline RA, Putman CE, Simeone J, Stark P. The apical cap. AJR Am J Roentgenol 1981;137:299-306 
  13. Panagopoulos N, Leivaditis V, Koletsis E, Prokakis C, Alexopoulos P, Baltayiannis N, et al. Pancoast tumors: characteristics and preoperative assessment. J Thorac Dis 2014;6 Suppl 1:S108-115 
  14. Monnier-Cholley L, Arrive L, Porcel A, Shehata K, Dahan H, Urban T, et al. Characteristics of missed lung cancer on chest radiographs: a French experience. Eur Radiol 2001;11:597-605 
  15. De Groot PM, Carter BW, Abbott GF, Wu CC. Pitfalls in chest radiographic interpretation: blind spots. Semin Roentgenol 2015;50:197-209 
  16. Muhm JR, Miller WE, Fontana RS, Sanderson DR, Uhlenhopp MA. Lung cancer detected during a screening program using four-month chest radiographs. Radiology 1983;148:609-615 
  17. Humphrey KL, Wu CC, Gilman MD, El-Sherief AH, Shepard JA, Abbott GF. Where are they all hiding? Common blind spots on chest radiography. Contemp Diagn Radiol 2011;34:1-5 
  18. Sarkar S, Jash D, Maji A, Patra A. Approach to unequal hilum on chest X-ray. J Assoc Chest Physicians 2013;1:32 
  19. Collins J, Stern EJ. Chest radiology: the essentials. Philadelphia: Lippincott Williams & Wilkins 2012:1-15 
  20. Wu CC, Khorashadi L, Abbott GF, Shepard JA. Common blind spots on chest CT: where are they all hiding? Part 2, Extrapulmonary structures. AJR Am J Roentgenol 2013;201:W671-W677 
  21. Mahoney MC, Shipley RT, Corcoran HL, Dickson BA. CT demonstration of calcification in carcinoma of the lung. AJR Am J Roentgenol 1990;154:255-258 
  22. Fraser RG, Pare JP. Diagnosis of diseases of the chest. Philadelphia: W.B. Saunders Company 1978 
  23. Khan AN, Al-Jahdali HH, Allen CM, Irion KL, Al Ghanem S, Koteyar SS. The calcified lung nodule: what does it mean? Ann Thorac Med 2010;5:67-79 
  24. Hebert C, George RB. Large fluid-filled thoracic mass in a young man. South Med J 1988;81:1322-1323 
  25. Venuta F, Rendina EA, Pescarmona EO, De Giacomo T, Vizza D, Flaishman I, et al. Occult lung cancer in patients with bullous emphysema. Thorax 1997;52:289-290 
  26. Hanaoka N, Tanaka F, Otake Y, Yanagihara K, Nakagawa T, Kawano Y, et al. Primary lung carcinoma arising from emphysematous bullae. Lung Cancer 2002;38:185-191 
  27. Tsutsui M, Araki Y, Shirakusa T, Inutsuka S. Characteristic radiographic features of pulmonary carcinoma associated with large bulla. Ann Thorac Surg 1988;46:679-683 
  28. Tan Y, Gao J, Wu C, Zhao S, Yu J, Zhu R, et al. CT characteristics and pathologic basis of solitary cystic lung cancer. Radiology 2019;291:495-501 
  29. Ichikawa T, Hattori A, Suzuki K, Matsunaga T, Takamochi K, Oh S, et al. Clinicopathological characteristics of lung cancer mimicking organizing pneumonia on computed tomography-a novel radiological entity of pulmonary malignancy. Jpn J Clin Oncol 2016;46:681-686 
  30. Aquino SL, Chiles C, Halford P. Distinction of consolidative bronchioloalveolar carcinoma from pneumonia: do CT criteria work? AJR Am J Roentgenol 1998;171:359-363 
  31. Stevic R, Milenkovic B. Tracheobronchial tumors. J Thorac Dis 2016;8:3401-3413 
  32. Song Y, Choi YW, Paik SS, Han DH, Lee KY. Endobronchial squamous cell carcinoma presenting as localized, long, continuous bronchial thickening on CT. Eur J Radiol 2017;91:99-105 
  33. Traill ZC, Maskell GF, Gleeson FV. High-resolution CT findings of pulmonary sarcoidosis. AJR Am J Roentgenol 1997;168:1557-1560 
  34. Moon WK, Im JG, Yeon KM, Han MC. Tuberculosis of the central airways: CT findings of active and fibrotic disease. AJR Am J Roentgenol 1997;169:649-653 
  35. Shiraishi J, Li Q, Appelbaum D, Doi K. Computer-aided diagnosis and artificial intelligence in clinical imaging. Semin Nucl Med 2011;41:449-462 
  36. Mayo RC, Leung J. Artificial intelligence and deep learning-Radiology's next frontier? Clin Imaging 2018;49:87-88