Underreporting of Malignant Central Airway Obstruction: A Retrospective Study of Radiology Reports in Patients Referred to a Comprehensive Cancer Center

<a href="https://journals.lww.com/bronchology/fulltext/2026/04010/underreporting_of_malignant_central_airway.9.aspx"><img src="https://images.journals.lww.com/bronchology/SmallThumb.01436970-202604010-00009.F1.jpeg" border="0" align ="left" alt="image"/></a>Background: Malignant central airway obstruction (MCAO) is a common complication of lung cancer. Cross-sectional imaging is the best method of screening for this complication, but prior data indicate that such obstruction is frequently underreported on radiology reports. Methods: A cohort with known MCAO was selected and radiology reports were reviewed. Data on scan indication, airway obstruction severity intravenous contrast use were tracked, as were relevant dates. Data on diagnostic and therapeutic bronchoscopy were also tracked. Results: The frequency of missed MCAO across mild and severe obstruction was 54%. Mild obstruction was missed more frequently than severe obstruction 77% versus 46%. Symptom-based versus scheduled-based scans had no significant difference in identification rates (53% vs. 58%). Contrast enhancement versus noncontrast did not significantly impact identification rates (44% vs. 56%). Airway obstruction identification was associated with a significantly faster time to first clinic appointment (8 vs. 11 d), but not with a significant difference in patient survival. Conclusion: Radiology underreporting of MCAO occurs at rates higher than previously demonstrated, with better detection of severe over mild obstruction. Other clinical parameters do not appear to significantly impact rates of identification. Identification is significantly associated with shorter times to first visit evaluation.