The additional value of the lateral chest radiograph for the detection of small pulmonary nodules-a ROC analysis.
OBJECTIVE
For the past 30 years, many authors have described different advantages of the use of the additional lateral chest radiograph. However, some radiologic departments gave up performing the lateral view recently. A potential reason for this might be a lack of evidence for any diagnostic benefit of the additional lateral view of the thorax in recent studies. The objective of this study was to evaluate the diagnostic benefit of the additional lateral view for the detection of small pulmonary nodules compared with CT examinations as a gold standard.


METHODS
The patient population consisted of 45 patients with SPN and 45 patients without SPN. Four radiologists with varying experience in the assessment of thoracic imaging first examined the sole posteroanterior (PA) projection. After a few days, they were instructed to examine the PA and the additional lateral view. A receiver-operating characteristic analysis was accomplished to compare the documented results.


RESULTS
The mean Az value of the sole PA view was 0.75 and 0.77 by the combination of PA and additional lateral view. So, there was no significant difference between the detectable Az values (Δ = 0.02; p = 0.384). With a cut-off value of >3, the additional view even reduced the sensitivity by averaging to 5.6%. The decrease of sensitivity by using the additional view was most detectable within the group of more experienced radiologists.


CONCLUSIONS
The additional lateral view of the chest provides no diagnostic benefit in the detection of small pulmonary nodules in comparison with the sole PA projection. Nevertheless, the results of the present study must not be understood as a general evaluation of the benefits of the lateral radiograph per se, because we did not examine other relevant issues (i.e. cardiac failure, lung parenchyma diseases or abnormalities in hilar anatomy). Advances in knowledge: Our study demonstrates a lack of evidence for any diagnostic benefit of the additional lateral view of the thorax in detecting SPN.
1 Zentrum für Diagnostische und Interventionelle Radiologie, Allgemeines Krankenhaus Hagen, Hagen, Germany.
Robin Alexander
RA
Kluthke
2 Institut für Radiologie, Universitätsklinikum Würzburg, Würzburg, Germany.
Ralph
R
Kickuth
3 Institut für Diagnostische und Interventionelle Radiologie, Krankenhaus Porz am Rhein, Köln, Germany.
Paul Martin
PM
Bansmann
1 Zentrum für Diagnostische und Interventionelle Radiologie, Allgemeines Krankenhaus Hagen, Hagen, Germany.
Carolin
C
Tüshaus
4 Institut für Diagnostische, Interventionelle Radiologie und Nuklearmedizin, Katholisches Marienhospital Herne Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany.
Stephan
S
Adams
4 Institut für Diagnostische, Interventionelle Radiologie und Nuklearmedizin, Katholisches Marienhospital Herne Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany.
Dieter
D
Liermann
1 Zentrum für Diagnostische und Interventionelle Radiologie, Allgemeines Krankenhaus Hagen, Hagen, Germany.
Johannes
J
Kirchner
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging*; D012372:ROC Curve; D013902:Radiography, Thoracic / Q000379:methods*