title: Missed lung cancer: when, where, and why?
abstract: Missed lung cancer is a source of concern among radiologists and an important medicolegal challenge. In 90% of the cases, errors in diagnosis of lung cancer occur on chest radiographs. It may be challenging for radiologists to distinguish a lung lesion from bones, pulmonary vessels, mediastinal structures, and other complex anatomical structures on chest radiographs. Nevertheless, lung cancer can also be overlooked on computed tomography (CT) scans, regardless of the context, either if a clinical or radiologic suspect exists or for other reasons. Awareness of the possible causes of overlooking a pulmonary lesion can give radiologists a chance to reduce the occurrence of this eventuality. Various factors contribute to a misdiagnosis of lung cancer on chest radiographs and on CT, often very similar in nature to each other. Observer error is the most significant one and comprises scanning error, recognition error, decision-making error, and satisfaction of search. Tumor characteristics such as lesion size, conspicuity, and location are also crucial in this context. Even technical aspects can contribute to the probability of skipping lung cancer, including image quality and patient positioning and movement. Albeit it is hard to remove missed lung cancer completely, strategies to reduce observer error and methods to improve technique and automated detection may be valuable in reducing its likelihood.
authors.affiliation: Institute of Radiology, Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome, Italy. paegiodi@hotmail.com.
authors.forename: Annemilia
authors.initials: A
authors.lastname: Del Ciello
authors.forename: Paola
authors.initials: P
authors.lastname: Franchi
authors.forename: Andrea
authors.initials: A
authors.lastname: Contegiacomo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cicchetti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Larici
mesh_terms: D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008400:Mass Chest X-Ray / Q000379:methods; D012307:Risk Factors; D014057:Tomography, X-Ray Computed