Clinical Features of Lung Cancers Discovered as a Postmortem “Surprise”

doi:10.1378/chest.90.4.520

Chest

Volume 90, Issue 4, October 1986, Pages 520-523

https://doi.org/10.1378/chest.90.4.520 Get rights and content

Despite improved modern diagnostic techniques, many patients with primary lung cancer escape detection of their disease during life. In a review of postmortem records at a university hospital, 28 percent of 153 primary lung cancers found at necropsy had not been diagnosed while the patient was alive. The male/female ratio was 1.3 in this undetected group, compared with 2.3 in the detected group. The main clinical features that seemed to lead to nondiagnosis were a terminal clinical state in patients who were too sick for further diagnostic searches, the absence of suggestive primary symptoms, a chest x-ray film interpreted as not showing primary lung cancer, and the absence of cigarette smoking. Among the patients with lung cancer at necropsy, the proportion of nonsmokers was higher in the previously undiagnosed group than in the group with antemortem diagnoses, even when patients were stratified for primary symptoms. The findings suggest the need for diagnostic alertness to the possibility that curable lung cancer can occur in patients who have a positive chest-film lesion but who are nonsmokers and who lack typical symptoms.

Section snippets

MATERIALS AND METHODS

The pathology files at the Yale-New Haven Hospital, New Haven, Conn, were reviewed to collect information about age, gender, and diagnosis of all necropsies between September 1971 and May 1982. During this period of time, 35 percent of all adult deaths had necropsies, with similar proportions in men and women.

Necropsies performed in patients under the age of 20 years or for medicolegal reasons were excluded from further consideration. For each postmortem diagnosis of primary carcinoma of the

RESULTS

From September 1971 through May 1982, the 3,286 necropsies performed at Yale-New Haven Hospital for persons aged 20 years or older included 1,761 men (54 percent) and 1,525 women (46 percent). Primary lung cancer was found in 159 patients, of whom six were excluded from this study; in one patient, the clinical information was insufficient, and in five, their only contact with Yale-New Haven Hospital was referral for necropsy. Of the 153 remaining patients with lung cancer, 101 were men, and 52

DISCUSSION

The results show that 28 percent (43/153) of the lung cancers found at necropsy at a university teaching hospital had not been diagnosed during life. The rate of premortem nondiagnosis for lung cancer is similar to the 31 percent rate of “underdiagnosis” in a recently reported¹ study of necropsies in the United Kingdom. The nondetection rates of 28 to 31 percent are much higher than would be expected with modern diagnostic methods for a disease that is generally regarded as progressive and

ACKNOWLEDGMENTS

We thank Ms. Susan Coppola, Ms. Iris Dyer, Ms. Carrol Ludington, Ms. Mary Newbury, Ms. Elizabeth Pesapane, and Ms. Angela Voss for secretarial assistance and J. G. Walker Smith, M.D., Director of the Autopsy Service at the Yale-New Haven Hospital, for his helpful cooperation.

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Presented at the annual meeting of the American Federation for Clinical Research, Washington, DC, May 4–7, 1984.

§Supported in part by grants from the A. W. Mellon Foundation and The Tobacco Research Council (grant No. 1443)

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Clinical InvestigationsClinical Features of Lung Cancers Discovered as a Postmortem “Surprise”

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

ACKNOWLEDGMENTS

The autopsy and clinical diagnosis

J Roy Coll Phys London

The incidence of intrathoracic neoplasia in the teaching hospitals of Great Britain, 1894–1928

Q J Med

Lung cancer

Clinical Investigations
Clinical Features of Lung Cancers Discovered as a Postmortem “Surprise”