Chest
Clinical Investigations: Lung CancerDetecting Lung Cancer as a Cause of Hemoptysis in Patients with a Normal Chest Radiograph: Bronchoscopy vs CT
Section snippets
Baseline Model
In patients presenting with hemoptysis and a normal CXR, there would be an initial choice between performing FOB or CT. A positive CT result requires a follow-up test to obtain histologic/cytologic confirmation of malignancy. Central airway abnormalities seen on CT would be assessed by FOB and parenchymal abnormalities suspicious for a lung cancer by TTNA. Because both FOB and CT may not detect all lung cancers, serial follow-up CXRs follow each negative result. During this follow-up period,
Baseline Model and Estimates
Using the baseline model and assumptions, with both the FOB and CT approaches, five cancers are discovered during the initial evaluation and one cancer is found through serial follow-up (Fig 1). Because both approaches result in approximately the same number of serial follow-up CXR examinations for all analyses, the NTND has been calculated as the number of FOB, CT, and TTNA studies performed with each option. The CT approach results in a NTND of 133, higher than the NTND of 101 for FOB, due to
Discussion
Objective guidelines are becoming increasingly important to clinicians in their choice of diagnostic strategies for solving clinical problems. The NTND is relatively simple to calculate and provides readily understandable information to the clinician about the impact of a first diagnostic test on the workload needed to solve a clinical problem. In the clinical scenario of a patient presenting with hemoptysis and a normal CXR, the dilemma revolves around identifying the few patients with lung
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Cited by (42)
Diagnosis and Treatment of Hemoptysis
2016, Archivos de BronconeumologiaClinical Aspects of Lung Cancer
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionClinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines
2013, ChestCitation Excerpt :Patients may dismiss small amounts of blood streaking in sputum as related to bronchitis and cough. However, hemoptysis may be the presenting symptom of lung cancer even in the setting of a normal or nonlocalizing chest radiograph.12 Persistent hemoptysis, even in scant amounts, in patients with a history of smoking and COPD should raise concern about the possibility of endobronchial tumor.
Early diagnosis of cancer by imaging: The primary care perspective
2012, RadiographyDiagnosing Cancer in the Symptomatic Patient
2009, Primary Care - Clinics in Office PracticeCitation Excerpt :Thus, for a patient with risk factors for and symptoms suggestive of bronchogenic cancer, such as a smoker older than the age of 40 with a history of COPD who presents with cough and hemoptysis, there should still be a high index of suspicion for lung cancer despite a normal chest radiograph. While a CT scan may be considered for further diagnostic evaluation, even CT scanning may fail to detect endobronchial cancers.53,54 Therefore, bronchoscopy is indicated when there is a high index of suspicion for lung cancer even when the chest radiograph is normal.42,45