A comparative study of mesothelioma and asbestosis using computed tomography and conventional chest radiography.

Abstract

A comparative study using computed tomography and conventional posteroanterior radiography was performed on 27 patients with mesothelioma and 13 patients with advanced asbestosis. The major pathologic features of both asbestosis and mesothelioma were well demonstrated by both modalities; computed tomography demonstrated the findings more frequently and in greater detail. No distinguishing features could be established based on configuration and size of the lesion. Many pleural plaques associated with advanced asbestosis were large and irregular and resembled those associated with mesothelioma. However, nodular involvement of the pleural fissures, pleural effusion, and ipsilateral volume loss with a fixed mediastinum were features predominating in mesothelioma. Growth determination of the plaques associated with asbestosis may be of minimal value since such plaques also undergo growth due to active inflammatory changes.

Malignant Pleural Mesothelioma Caused by Environmental Exposure to Asbestos in the Southeast of Turkey: CT Findings in 117 Patients

“…This tumor generally spreads locally [1], and may be detected as nodular masses which can be classified according to their source of origin as parenchymal extension or intraparenchymal. Parenchymal extension has been reported to contain pleural-based nodular masses extending into lung, whereas intraparenchymal masses were found to be round, sharply demarcated and located within the lung [18]. In our study, we detected lung penetration in 12 patients (10%), and these were pleural-based masses that extended into lung parenchyma.…”

“…The histopathological examination of tissue obtained from these lesions has revealed MPM. Similarly, Rabinowitz et al [18]reported that the intraparenchymal lesions histologically represented malignant mesothelioma in patients with mesothelioma, and thickened pleura in patients with asbestosis.…”

“…Volume contraction because of coverage of the lung by the fibrous component of the tumor, depression of the ipsilateral shoulder and findings of fixed chest may also be detected by X-ray. However, CT is known to be more accurate and reliable in diagnosing and determining the extent of mesothelioma [17, 18]. Selçuk et al [3]reported that the involvement of the mediastinal pleura and interlobar fissure was more detectable in CT scans compared to chest X-rays.…”

“…This suggests that the development of irregular plaques in the presence of smooth plaques may not be sufficient evidence for malignant degeneration. In their study comparing the radiological findings of mesothelioma and asbestosis, Rabinowitz et al [18]reported that irregular plaques alone were not a criterion of malignancy. Furthermore, these authors suggested that a plaque is not a static structure, since active inflammatory changes are associated with pleural asbestosis, and that a plaque may continue to grow and alter its configuration periodically [18].…”

“…Calcified pleural plaques were rarely seen, in only 3% of our cases. Similarly, Rabinowitz et al [18]reported that these plaques were infrequently encountered in mesothelioma either via CT or radiography, and suggested that this could be a result of the absorption of the calcification by the tumor [13]. …”