Asbestos Surveillance Program Aachen (ASPA): initial results from baseline screening for lung cancer in asbestos-exposed high-risk individuals using low-dose multidetector-row CT

Abstract

The purpose of this study was to assess the prevalence of lung cancer in a high-risk asbestos-exposed cohort using low-dose MDCT. Of a population of 5,389 former power-plant workers, 316 were characterized as individuals at highest risk for lung cancer according to a lung-cancer risk model including age, asbestos exposure and smoking habits. Of these 316, 187 (mean age: 66.6 years) individuals were included in a prospective trial. Mean asbestos exposure time was 29.65 years and 89% were smokers. Screening was performed on a 16-slice MDCT (Siemens) with low-dose technique (10/20 mAs(eff.); 1 mm/0.5 mm increment). In addition to soft copy PACS reading analysis on a workstation with a dedicated lung analysis software (LungCARE; Siemens) was performed. One strongly suspicious mass and eight cases of histologically proven lung cancer were found plus 491 additional pulmonary nodules (average volume: 40.72 ml, average diameter 4.62 mm). Asbestos-related changes (pleural plaques, fibrosis) were visible in 80 individuals. Lung cancer screening in this high-risk cohort showed a prevalence of lung cancer of 4.28% (8/187) at baseline screening with an additional large number of indeterminate pulmonary nodules. Low-dose MDCT proved to be feasible in this highly selected population.

Low-Dose Computed Tomography Screening for Lung Cancer and Pleural Mesothelioma in an Asbestos-Exposed Population: Baseline Results of a Prospective, Nonrandomized Feasibility Trial—An Alpe-Adria Thoracic Oncology Multidisciplinary Group Study (ATOM 002)

“…Overall, the study showed some inaccuracy in the diagnostic workup of suspicious findings and incongruity in their treatment [20]. More recently, two small studies were conducted, each including an asbestos-exposed cohort of Ͻ200 individuals [21,22]. Notably, in all three cases, study participants were mostly smokers/former smokers (97%, 99%, and 100%, respectively).…”

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

“…Although not proven, such nodules may be best found with multi-slice CTs by using thin cuts. In a multi-slice CT study with 0.75 mm collimation, 1 mm slice reconstruction and 0.5 mm increment 163 screened persons out of 187 (87 %) had one or more nodules, out of which 75 % fell in the smallest category, 3-5 mm in size [12]. All lung cancer in their series had a diameter of 15 mm or more.…”

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.…”