Can lung cancer be detected by chest X-ray

After a patient with advanced lung cancer was diagnosed, he sued the medical examination center that had issued a normal chest X-ray 10 months ago. After mediation, he was awarded 125,000 yuan in compensation for missed diagnosis. This medical dispute has triggered some thoughts: Is chest X-ray still necessary in lung cancer screening? Some experts believe that if this chest X-ray is shown to other specialists and they find that the film is abnormal, the medical examination center will be responsible for missed diagnosis and delayed treatment; if all doctors unanimously say that they did not find any abnormality in the chest X-ray, the medical examination center does not need to bear any responsibility.

There are many clinical screening methods for lung cancer. The most commonly used method is chest X-ray. However, Professor Wang Changli pointed out that in fact, X-ray examination is not the best and most direct screening effect for lung cancer. It is recommended to choose low-dose chest CT examination, which is also the most important screening method in clinical practice. Patients with conditions can also choose other screening methods, such as PET-CT and MRI. Other screening methods include sputum cytology, bronchoscopy and percutaneous fine needle aspiration biopsy.

People at high risk of lung cancer: long-term smokers over 40 years old (3 "20": smoking over 20 years old; smoking under 20 years old; smoking more than 20 cigarettes a day); frequent contact with cigarette ash, coal tar and soot; radiation exposure (miners, etc.); long-term contact with inorganic arsenic, asbestos, chromium, nickel; chronic; patients with lung diseases such as tuberculosis; those with a family history of lung cancer; chronic cough and blood in sputum.

A piece of news titled "Patient's treatment delayed due to lack of lung cancer detected during physical examination was compensated 125,000 yuan" caused a small controversy in the medical community. Although the medical dispute was settled with Mr. Ma receiving 125,000 yuan in compensation, it left us with something to think about: Why was lung cancer not detected in a patient with advanced stage during a chest X-ray physical examination 10 months ago?

Lung cancer patient's chest X-ray 10 months ago showed normal results, experts say it is entirely possible

Since this patient was already "right lung cancer stage IV, with systemic metastasis", why did the chest X-ray 10 months ago show normal results? Regarding this case, some experts said that even if "no abnormality is found in the chest anteroposterior X-ray", it does not mean that there is no mass in the chest. There are several possibilities:

First, the lung mass is relatively small. This is determined by the limitations of chest X-rays. Lung masses with a diameter of less than 0.5 cm or even 1 cm may not be visible on chest X-rays. Lung cancer is not a disease that occurs suddenly. It is a relatively slow process in which lung masses grow from small to large. Not being visible on chest X-rays does not mean that there is no lung mass.

Second, the location of lung tumors is relatively hidden. Generally speaking, tumors growing around the lungs are easier to detect, while tumors near the heart, spine, hilum, etc. are easily obscured by these organs and missed. Director Yang specifically pointed out that the physical examination results mentioned in the incident showed that "no abnormalities were found in the chest anteroposterior film", and the "chest anteroposterior film" provided an opportunity for missed diagnosis of the above lung tumors near the heart, spine, hilum, mediastinum, etc.

Third, the density of the lung mass is relatively low. From the perspective of imaging, the density of normal lung tissue is relatively low, while the density of the heart, mediastinum, spine and other parts is relatively high. If the density of the lung mass itself is relatively low, it will be more easily confused with normal tissue, thus further increasing the difficulty of finding suspicious points through chest X-rays.

Taking into account objective factors such as the size, location, and density of lung masses, as well as subjective factors such as the doctors' experience, it is entirely possible that the "chest AP X-ray" failed to detect lung masses.

Chest X-ray is still an important part of lung cancer screening during physical examinations

Since chest X-rays have so many limitations, is it still necessary for ordinary people to have chest X-rays taken during their physical examinations? Experts point out that "for daily health examinations of normal people, ordinary X-rays such as chest X-rays play a very special and important role in lung lesions." Among the many lung cancer examination items currently available, each has its indications, advantages and disadvantages. Therefore, it is necessary to combine the advantages and disadvantages of several items for a comprehensive diagnosis.

Unlike most medical examination institutions that only take chest AP films, when encountering patients who suspect they have lung problems and come to the hospital for treatment, doctors generally ask them to take AP and lateral films at the same time. This is because some lung masses that are easy to hide in AP chest films can be found from a different angle by taking lateral films, so as to conduct the next step of diagnosis, such as CT. Therefore, taking AP and lateral films at the same time can increase the detection rate of chest masses.

In addition, the examination fee is relatively low, ranging from a few dozen yuan to more than a hundred yuan, and chest X-ray is still an important item in physical examinations to screen for lung cancer.