Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings

Abstract

The objective of the present study is to determine the feasibility of chest computed tomography (CT) in screening for lung cancer among asbestos-exposed workers.In total, 633 workers were included in the present study and were examined with chest radiography and high-resolution CT (HRCT). A total of 180 current and ex-smokers (cessation within the previous 10 yrs) were also screened with spiral CT. Noncalcified lung nodules were considered positive findings. The incidental CT findings not related to asbestos exposure were registered and further examined when needed.Noncalcified lung nodules were detected in 86 workers. Five histologically confirmed lung cancers were found. Only one of the five cancers was also detected by plain chest radiography and three were from the group of patients with a pre-estimated lower cancer probability. Two lung cancers were stage Ia and were radically operated. In total, 277 individuals presented 343 incidental findings of which 46 required further examination. Four of these were regarded as clinically important.In conclusion, computed tomography and high-resolution computed tomography proved to be superior to plain radiography in detecting lung cancer in asbestos-exposed workers with many confounding chest findings. The numerous incidental findings are a major concern for future screenings, which should be considered for asbestos-exposed ex-smokers and current smokers.

Imaging of malignant pleural mesothelioma: it is possible a screening or early diagnosis program?—a systematic review about the use of screening programs in a population of asbestos exposed workers

“…From 2002 to 2009, the results of some lung cancer screening trials with LDCT on asbestos-exposed workers were published (29)(30)(31)(32)(33)(34). Unfortunately, in these studies CT image acquisition and reconstruction algorithms are different as well as technical parameters (mA, slice thickness, reconstruction interval, additional HRCT slices, etc.…”

“…); furthermore, the criteria to determine a positive test are not homogeneous. Most of all use ELCAP, I-ELCAP criteria (22,23) or a modification of these (29,31,32,35) to determine a positive test for non-calcific nodule; in other trials the presence of pleural abnormalities is a criterion considered for a positive test (29)(30)(31)(32), but the definitions of pleural involvement and subsequent work-up are various and not always included in the protocol study.…”

Genetic susceptibility to asbestos-related fibrotic pleuropulmonary changes

“…The first study group (n5602) was recruited in 1996-1997 and consisted of asbestos-exposed subjects who lived in the Helsinki (Finland) area, and had an asbestos-related occupational disease and a smoking history [22,23]. The second study group (n5633) was recruited in [2003][2004], and consisted of asbestos-exposed persons from three geographic areas (Helsinki, Tampere and Turku, Finland) who were heavily exposed, had previously been diagnosed with asbestos-related occupational disease, or had visited occupational medicine clinics in Helsinki and Tampere for clinical follow-up [24].…”

Factors influencing the prevalence of pulmonary nodules in lung cancer screening trials: re-evaluation of a CT study

“…A recent paper showed that cancers found in such screening have a favourable prognosis [1]. One of the major limitations of CT screening is the large number of non-specific lung nodules, ranging from 6.7 % or 14 % [2][3][4] in baseline screening up to 74 % among those repeatedly screened [5]. These findings cause a great burden, because their benign nature has to be confirmed with extra studies.…”