Is post-pneumonia chest X-ray for lung malignancy useful? Results of an audit of current practice

Patients with community-acquired pneumonia (CAP) are often screened with repeat chest X-ray within 6-12 weeks following an admission. This practice is aimed to detect underlying lung malignancy, which can be difficult to identify initially when an acute infiltrate is present on X-ray. We conducted a study on the use of follow-up chest X-rays after an admission with CAP to determine the yield of suspected or diagnosed cancer.

During the 2-year period, January 2010-January 2012, we evaluated all patients over the age of 50 who had no previous history of lung cancer and were admitted to Hutt Hospital with CAP.

A total of 302 patients was included. Of these, 53% received a follow-up chest X-ray within 6-12 weeks after admission. A total of six patients (2.0%) was diagnosed with lung cancer based on a chest X-ray within 6-12 weeks after admission. After a median period of follow up of 19.5 months, a further five patients who had normal chest X-ray were diagnosed with lung malignancy.

The majority of patients were screened with follow-up X-rays. The yield from a 6- to 12-week chest X-ray following CAP is low, which is consistent with previous studies. The development of clear guidelines to ensure identification of patient groups at significantly high risk of lung cancer is important to increase the sensitivity of screening. High yielding strategies, such as low-dose computed tomography, should be considered as an alternative.