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

¹ Dept of Diagnostic Radiology, ² Clinic of Occupational Medicine, ³ Dept of Cardiothoracic Surgery, Heart Center, ⁴ Dept of Pulmonary Diseases, Tampere University Hospital, Tampere, ⁵ Helsinki Medical Imaging Center, ⁶ Division of Respiratory Diseases, Dept of Medicine, Helsinki University Central Hospital, ⁷ Finnish Institute of Occupational Health (FIOH), ⁸ Dept of Radiology, ⁹ Dept of Pulmonary Diseases, Turku University Hospital, and ¹⁰ Finnish Institute of Occupational Health, Turku, Finland.

CORRESPONDENCE: T. Vierikko, Radiologist, Tampere University Hospital, FI-33101 Tampere, Finland. Fax: 358 331163013. E-mail: tuula.vierikko{at}fimnet.fi

Keywords: Asbestos, computed tomography, incidental findings, lung cancer, occupational exposure

Received: June 5, 2006
Accepted October 7, 2006

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.

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