. 2014 Aug;60(8):e395–e404.

Table 3.

Primary studies and results from updated literature review

STUDY	STUDY TYPE AND SETTING	STUDY DETAILS	STUDY RESULTS
Signs, symptoms, risk factors, and other clinical features associated with the presentation of lung cancer
• Ak et al,¹⁹ 2007, Turkey	Retrospective; secondary care	N = 1340 patients with lung cancer; compared symptom and sign presentation between younger (< 50 y, n = 179) and older (≥ 50 y, n = 1161) patients	Chest pain was more common in younger patients, while cough and dyspnea were more common in older patients. Occupational exposure was a risk factor in the younger group, while smoking was a risk factor in the older group
• Beatty et al,²⁰ 2009, New Zealand	Retrospective; secondary care	N = 159 patients with lung cancer; n = 66 referred by GPs	Of 66 patients referred by GPs: 47% presented with respiratory symptoms, 38% presented with hemoptysis, and 31% presented with no hemoptysis. Symptom duration varied from < 1 wk (35%, n = 16) to > 2 mo (33%, n = 8)
• Chandra et al,²¹ 2009, India	Retrospective; tertiary care	N = 165 patients with lung cancer	Main clinical features at the time of diagnosis of lung cancer included coughing (75.2%), shortness of breath (66.9%), weight loss (63.7%), chest pain (63.1%), hemoptysis (33.1%), hoarseness of voice (29.3%), excessive weakness or fatigue (26.8%), clubbing (22.9%), dysphagia (9.3%), and superior vena cava syndrome (8.0%)
• Koumarianou et al,²⁴ 2009, Greece	Retrospective; cancer registry, mainly from phase II and III trials	N = 1906 with non–small cell lung cancer; compared symptom characteristics of 417 patients ≥ 70 y (elderly); 1374 patients 45–70 y; and 115 patients ≤ 45 y (young)	Most commonly reported symptoms: hemoptysis, cough, and weight loss. Elderly patients presented with more symptoms such as pain, dyspnea, cough, and fatigue compared with young patients
• Lovgren et al,²⁵ 2008, Sweden	Retrospective; secondary care	N = 314 with lung cancer	Five of the most commonly reported first symptoms were cough, dyspnea, weight loss, fatigue, and thoracic pain. Four of the most common symptoms triggering health care system appointments included cough, dyspnea, and thoracic pain for men and women, and neurologic symptoms for women and hemoptysis for men
• Thammakumpee et al,²⁶ 2007, Thailand	Retrospective; secondary care	N = 116 with small cell lung cancer	Symptoms and signs, in order of frequency, included cough, weight loss, dyspnea, chest pain, hemoptysis, hoarseness, superior vena cava syndrome, neurologic syndrome, syndrome of inappropriate antidiuretic hormone, Cushing syndrome, and massive hemoptysis
• Thomas et al,²⁷ 2008, India	Retrospective; tertiary care	N = 25 with pulmonary carcinoid tumours	Presenting symptoms or signs included hemoptysis, cough, breathlessness, chest pain, fever, and superior vena cava syndrome
• Uzun et al,²⁸ 2010, Turkey	Prospective; tertiary care	N = 178 with hemoptysis; n = 51 (29%) with lung cancer	Of 51 patients with lung cancer: 32% had mild hemoptysis, 38% had moderate hemoptysis, 24% had severe hemoptysis, and 13% had massive hemoptysis
• Yaman et al,²⁹ 2009, Turkey	Retrospective; secondary care	N = 109 with lung cancer	First symptoms related to lung cancer grouped into 5 categories were cough (32%), dyspnea (21%), hemoptysis (11%), chest pain (20%), and other first symptoms (16%)

Diagnostic accuracy of tests to investigate clinical suspicion of lung cancer
• Choi et al,²² 2008, Korea	Retrospective; secondary care	N = 955; 352 histologically confirmed; n = 127 (36%) with lung cancer	Compared the diagnostic accuracy of sputum samples from a hospital using CP vs TP methods.²² The diagnosis of lung cancer was confirmed histologically. The sensitivity of TP and CP were 50.4% and 30.6%, respectively. The specificity was 99.1% with TP and 100.0% with CP
• Kemp et al,²³ 2007, Canada	Prospective; secondary care^*	N = 1123 with medical history or clinical symptoms suspicious for lung cancer; n = 370 (33%) with lung cancer	Smears were assessed by conventional cytology (reference standard) or using an automated technique (LungSign test).²³ LungSign showed a sensitivity of 40% and a specificity of 91%

CP—conventional preparation, TP—ThinPrep.