Screening for Malignant Pleural Mesothelioma and Lung Cancer in Individuals with a History of Asbestos Exposure

Heidi C. Roberts, Demetris A. Patsios, Narinder S. Paul, Marc dePerrot, Warren Teel, Hamid Bayanati, Frances Shepherd, Michael R. Johnston
2009 Journal of Thoracic Oncology  
Purpose: We established a screening program for prior asbestos workers using low-dose computed tomography (LDCT). Methods: Between March 2005 and October 2007 we performed LDCT (50 -60 mA, 120 kV, 1.25 mm) in 516 asbestos-exposed individuals. Parenchymal nodules were followed according to lung cancer screening recommendations, morphology and location of pleural plaques was noted in detail. Results: We included 507 men and 9 women (median 60.0 years), 395 (76.6%) were smokers. Annual repeat has
more » ... een performed in 356 participants. We found plaques in 357 subjects (69.2%), commonly calcified (79.6%), flat (86.6%), and symmetric (86.8%), and mostly involving the costal (96.4%) and diaphragmatic (81.8%) pleura. Uncommon plaques were lobulated (13.2%), right-dominant asymmetric (4.5%), or with effusions (0.1%). We found pulmonary nodules in 371 subjects (71.9%), 91 (17.6%) had at least one nodule Ն5 mm; 10 growing nodules were found on annual repeat LDCT. In 41 individuals, plaques were regarded as atypical; three had new pleural/peritoneal abnormalities on annual repeat LDCT. An interim limited computed tomography of the observed abnormality prompted 10 diagnostic biopsies, resulting in a diagnosis of six lung cancers, two pleural mesothelioma and two peritoneal mesothelioma; overall rate of screen-detected malignancies is 2.1%. There were four interval cancers, diagnosed after baseline (n ϭ 1) or after the annual repeat (n ϭ 3): two pleural and one peritoneal mesothelioma, and one mixed squamous/small cell carcinoma. Conclusion: Screening prior asbestos workers detects advanced malignant pleural mesothelioma and early as well as late stage lung cancer. We expect to learn more about the appearance of "early mesothelioma" with continued screening. FIGURE 4. Annual repeat screening low-dose computed tomography (LDCT) of a 68-year-old man. The annual repeat demonstrates intra-abdominal, prehepatic soft tissue nodules which were not present on the baseline. Subsequent investigations revealed a malignant peritoneal mesothelioma.
doi:10.1097/jto.0b013e31819f2e0e pmid:19357540 fatcat:uvoey23t2fcvhkn4fxugudiym4