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Chest X-rays in COPD screening: are they worthwhile?

G M F Wallace1, J H Winter, J E Winter

  • 1Respiratory Unit, Ninewells Hospital, Dundee DD1 9SY, UK.

Respiratory Medicine
|July 28, 2009
PubMed
Summary
This summary is machine-generated.

Chest X-rays during initial COPD assessment detect significant other pathologies, altering patient management in most cases. This supports upgrading the recommendation for this diagnostic tool.

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Area of Science:

  • Respiratory Medicine
  • Diagnostic Imaging
  • Clinical Guidelines

Background:

  • The British Thoracic Society/National Institute for Health and Care Excellence (BTS/NICE) guideline recommends chest X-ray (CXR) for initial COPD evaluation (Grade D).
  • The current recommendation is based on expert opinion, necessitating further investigation into the diagnostic yield of CXR in this context.

Purpose of the Study:

  • To investigate the range of pathologies, beyond COPD, detected by CXR during initial patient assessment.
  • To evaluate how these detected pathologies influence clinical management decisions.

Main Methods:

  • Retrospective analysis of 546 consecutive chest X-ray reports and patient case records.
  • Patients included were smokers aged 40+ receiving bronchodilators, assessed for COPD, and without a recent CXR.
  • CXR reports were structured with specific questions regarding alternative causes of dyspnea and potential lung cancer.

Main Results:

  • Fourteen percent of CXRs identified potentially treatable diseases causing dyspnea, with 84% of these cases showing management changes.
  • Eleven lung cancers were detected, including three at Stage 1.
  • Significant benign and malignant pathologies were identified, impacting clinical decisions.

Conclusions:

  • Chest X-ray during initial COPD assessment reveals considerable treatable benign and malignant pathology.
  • Clinical management is frequently altered by CXR findings, supporting its utility.
  • Evidence suggests upgrading the NICE guideline recommendation for CXR in initial COPD evaluation from Grade D to Grade C.