title: Improved Lung Cancer Detection in Cardiovascular Outpatients by the Pulmonologist-based Interpretation of Chest Radiographs.
abstract: OBJECTIVE
  Pulmonologists and cardiologists view chest radiographs differently. Lung cancer may therefore go undetected in patients referred to cardiovascular departments. We aimed to determine the clinical benefit of the additional interpretation of chest radiographs by pulmonologists in study involving cardiovascular outpatients.
  
  
  METHODS
  A retrospective review of chest radiographs of outpatients attending a Japanese cardiovascular hospital between April 2000 and March 2010 was conducted. Lung cancer patients were categorized into 3 groups: group C, patients in whom tumors were detected by a cardiologist at the first visit; group P, patients in whom tumors were detected by the additional interpretation of a chest radiographs by a pulmonologist after a lesion was missed by a cardiologist; and group H, patients from an earlier period in which chest radiographs were only examined by a cardiologist.
  
  
  RESULTS
  Cardiologists detected 9 cases of lung cancer in groups C and H from 2,430 and 2,288 radiographs, respectively. Pulmonologists detected 10 cases of lung cancer (group P) and 3 other malignancies that were previously undetected, giving a miss rate of 52.6% for the cardiologists. Tumor diameters were significantly smaller in group P than in group C or H. Furthermore, a significantly higher number of the tumors in group P were of an early stage and resectable, with more superposing structures than in groups C or H.
  
  
  CONCLUSIONS
  The additional pulmonologist-based interpretations significantly increased the detection rate of operable tumors that mostly corresponded to the early T1 stage; this serves offers a potential clinical benefit in reducing the period of time from patient presentation to the diagnosis of lung cancer.
authors.affiliation: Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sakai
authors.forename: Akinori
authors.initials: A
authors.lastname: Kato
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Ryota
authors.initials: R
authors.lastname: Nakamura
authors.forename: Shuuichi
authors.initials: S
authors.lastname: Okawa
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sato
mesh_terms: D000368:Aged; D016507:Cardiology Service, Hospital; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010045:Outpatients; D010820:Physicians; D015272:Pulmonary Medicine; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012680:Sensitivity and Specificity