Alessandro Montedori, Ettore Bidoli, Diego Serraino, Mario Fusco, Gianni Giovannini, Paola Casucci, David Franchini, Annalisa Granata, Valerio Ciullo, Maria Francesca Vitale, Michele Gobbato, Rita Chiari, Francesco Cozzolino, Massimiliano Orso, Walter Orlandi, Iosief Abraha, for the D.I.V.O. Group.

BMJ Open 2018;8:e020628. doi:10.1136/ bmjopen-2017-020628.


OBJECTIVES To assess the accuracy of International Classification of Diseases 9th Revision–Clinical Modification (ICD-9-CM) codes in identifying subjects with lung cancer.


DESIGN A cross-sectional diagnostic accuracy study comparing ICD-9-CM 162.x code (index test) in primary position with medical chart (reference standard). Case ascertainment was based on the presence of a primary nodular lesion in the lung and cytological or histological documentation of cancer from a primary or metastatic site.


SETTING Three operative units: administrative databases from Umbria Region (890 000 residents), ASL Napoli 3 Sud (NA) (1 170 000 residents) and Friuli Venezia Giulia (FVG) Region (1 227 000 residents).


PARTICIPANTS Incident subjects with lung cancer (n=386) diagnosed in primary position between 2012 and 2014 and a population of non-cases (n=280).


OUTCOME MEASURES Sensitivity, specificity and positive predictive value (PPV) for 162.x code.

Results 130 cases and 94 non-cases were randomly selected from each database and the corresponding medical charts were reviewed. Most of the diagnoses for lung cancer were performed in medical departments.

True positive rates were high for all the three units. Sensitivity was 99% (95% CI 95% to 100%) for Umbria, 97% (95% CI 91% to 100%) for NA, and 99% (95% CI 95% to 100%) for FVG. The false positive rates were 24%, 37% and 23% for Umbria, NA and FVG, respectively. PPVs were 79% (73% to 83%)%) for Umbria, 58% (53% to 63%)%) for NA and 79% (73% to 84%)%) for FVG.


CONCLUSIONS Case ascertainment for lung cancer based on imaging or endoscopy associated with histological examination yielded an excellent sensitivity in all the three administrative databases. PPV was moderate for Umbria and FVG but lower for NA.