Tumores bronquiales carcinoides. Análisis de 41 casos

Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review

BACKGROUND

Despite increasing use of computed tomography (CT), chest X-ray remains the first-line investigation for suspected lung cancer in primary care in the UK. No systematic review evidence exists as to the sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms.

AIM

To estimate the sensitivity of chest X-ray for detecting lung cancer in symptomatic people.

DESIGN AND SETTING

A systematic review was conducted to determine the sensitivity of chest X-ray for the detection of lung cancer.

METHOD

Databases including MEDLINE, EMBASE, and the Cochrane Library were searched; a grey literature search was also performed.

RESULTS

A total of 21 studies met the eligibility criteria. Almost all were of poor quality. Only one study had the diagnostic accuracy of chest X-ray as its primary objective. Most articles were case studies with a high risk of bias. Several were drawn from non-representative groups, for example, specific presentations, histological subtypes, or comorbidities. Only three studies had a low risk of bias. Two primary care studies reported sensitivities of 76.8% (95% confidence interval [CI] = 64.5 to 84.2%) and 79.3% (95% CI = 67.6 to 91.0%). One secondary care study reported a sensitivity of 79.7% (95% CI = 72.7 to 86.8%).

CONCLUSION

Though there is a paucity of evidence, the highest-quality studies suggest that the sensitivity of chest X-ray for symptomatic lung cancer is only 77% to 80%. GPs should consider if further investigation is necessary in high-risk patients who have had a negative chest X-ray.

Surgical Management of Bronchopulmonary Carcinoid Tumors: Experience over 8 years and Review of the Literature

Aims and background

An increased incidence of neuroendocrine tumors in the last decade has been noticed worldwide. Our purpose was to study the characteristics, surgical approaches and outcome in patients with primary bronchopulmonary carcinoid tumors.

Methods

Between 2001 and 2007, bronchopulmonary carcinoid tumors were removed in 11 of a total of 287 patients who underwent surgery for primary lung malignancies in our tertiary referral center.

Results

The patient group consisted of 3 men and 8 women (mean age 52.9 ± 5.2 years, range 19–76 years). At presentation, 10 of 11 patients were symptomatic, with cough, pneumonia, breathlessness and hemoptysis being the most frequent symptoms. Histological findings revealed typical carcinoid in 10 patients and atypical carcinoid in one. The surgical approach included 8 lung resections (6 lobectomies, 1 bilobectomy, 1 segmentectomy), and 3 bronchoplastic tumor removals. In 2008, clinical examination and chest X-ray revealed no recurrence of the carcinoid and no long-term postoperative complications in any patient.

Conclusions

In the light of our study and the review of the literature we conclude that early recognition of primary bronchopulmonary carcinoid tumors followed by adequate surgical removal of the malignancy are essential for complete remission of the disease.