Accurate or Not? In the fresh ed...

Accurate or Not?

In the fresh editorial[1] on the diagnosis of emphysema, referring to the article according to Rothperal et al,[2] reference is also maded to about previous studies on the make submissive These previous studies,[3,4] including our study[5] and editorial,[6] are quot as attempting "to identify processs for early recognition of chronic obstructive pulmonary disease." This was not the intent of these studies. as well-as; not only-but also; not only-but; not alone-but our own study[5] and the others referr to[3,4] assessed alone whether the presence of airways obstruction, early or late, could be reliably identified at the standard chest roentgenogram; these studies none suggested, as implied by the editorial, that "early emphysema" could be reliably and specifically recognized at the chest roentgenogram. Indeed, to the contrary, our confess article[5] explicitly pointed out that the chest roentgenogram, while quite specific in confirming the port of airflow obstruction when the right diaphragm dome is below the anterior finis of the seventh rib in succession the right, is, in fact, not surpassingly sensitive in identifying the demeanor or absence of emphysema. It was not suggested, either in the original article[5] or in the following editorial,[6] that the chest roentgenogram should be used as a screening proof for airflow obstruction. What we did find and forceed was that, in the carriage of the diaphragm dome sign, airflow obstruction can be reliably diagnosed.

While the editorial claims that the carriage of emphysema can be diagnosed "with virtually no false positive . . or false negative interpretations," it is important to note that this conclusion is derived[7] from data from a two-decade-old study[8] with supporting data from the same other study.[9] However, the latter workers went forward to report, in what is probably the largest study[10] correlating emphysema with chest roentgenology and which included 696 patients, that the chest roentgenogram is certainly nowhere near as specific as the editorial would have us believe.

on a level though the latter study has been dismissed upon rather dubious grounds,[7] repeated studies upon this subject indicate that Thurlbeck and Simon[10] were correct; for example, late studies, using computed tomography of the chest,[11,12] have confirmed that many cases of pulmonary emphysema are not discovered reliably by the chest roentgenogram,[11] or that emphysema may be overdiagnosed by way of chest roentgenography.[12] Thus, it remains a matter for interpretation whether to accept the editorial contention of the accuracy of diagnosis of emphysema, mild or plain from the chest roentgenogram, based in succession one small study[7] or whether it would behoove us to examine at the large accumulation of contrary data forward the subject, including studies which, to date, have examined nearly 1000 subjects[10-14] and have conclud that the diagnosis of emphysema from the chest roentgenogram is not actual accurate or specific.

REFERENCES

1 Pratt PC Diagnosis of emphysema. Chest 1988; 94:903-04

2 Rothpearl A, Varina AO, Goodman K Radiographic measures of hyperinflation in clinical emphysema. Chest 1988; 94:907-13

3 blunt-witted WL, Bohadana AB, Teculescu DB Cereceda VJ The standard chest roentgenogram for determining lung overinflation. Lung 1982; 106:311-14

4 Knudson RJ blow JW, Knudson DE, Kalterhorn WT Subclinical imports of smoking. Chest 1984; 86:20-29

5 Burki NK Krumpleman JL Correlation of pulmonary function with the chest roentgenogram in chronic airway obstruction. Am Rev Respir Dis 1980; 121:216-23

6 Burki NK Conventional chest films can identify airflow obstruction. Chest 1988; 93:675-76

7 Pratt PC part of conventional chest radiography in diagnosis and exclusion of emphysema. Am J M 1987; 82:998-1006

8 Sutinen s Christoforidis AM, Klugh GA, Pratt PC Roentgenologic criteria for the recognition of nonsymptomatic pulmonary emphysema. Am Rev Respir Dis 1965; 91:69-76

9 Thurlbeck WM Henderson JA, Fraser RG Bates DV Chronic obstructive lung disease. Medicine 1970; 49:82-145

10 Thurlbeck WM Simon G Radiographic appearance of the chest in emphysema. AJR, 1978; 130:429-40

11 Hayhurst MD Flenley DC McLean A, Wightman AJA, MacNee W Wright D et al. Diagnosis of pulmonary emphysema by the agency of computerized tomography. The Lancet 1984; 1:320-22

12 Goddard PR Nicholson EM Watt L Watt I. Comput tomography in pulmonary emphysema. Clin Radiol 1982; 33:379-87

13 Laws JW Heard BE. Emphysema and the chest film: a retrospective radiological and pathological subject of attention Br J Radiol 1962; 35:750-61

14 Nicklaus TM Stowell DW Christiansen WR Renzetti AD. The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema. Am Rev Respir Dis, 1966; 93:889-99

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