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

Our plain-English summary of A comparative study of mesothelioma and asbestosis using computed tomography and conventional chest radiography, by J.G. Rabinowitz, S.C. Efremidis, B. Cohen, et al (Radiology, 1982).

The study

• Authors: J.G. Rabinowitz, S.C. Efremidis, B. Cohen, S. Dan, A. Efremidis, A.P. Chahinian, A.S. Teirstein
• Journal: Radiology
• Published: 1982;144(3):453-60
• Cited by: 55 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001804).

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.

In plain English

This study at Mount Sinai Hospital, New York, compared computed tomography (CT) with back-to-front (posteroanterior) chest radiographs. It included 27 patients with proved mesothelioma, all with underlying asbestosis, and 13 selectively chosen patients with advanced asbestosis. CT showed the disease features more often and in more detail. Excluding the fissures, involvement of all pleural compartments was seen on CT in all 27 mesothelioma patients and on radiographs in 22 of the 25 who had them (88%). Seven asbestosis patients had irregular, lobular pleural masses that could not be told apart from mesothelioma on either method, yet multiple biopsies or surgery found no malignant change. Pleural effusion was not seen in any asbestosis patient. It was seen in 12 mesothelioma patients on radiographs but in only four on CT, mostly done lying on the back. The authors concluded that three features may help tell mesothelioma from advanced asbestosis: nodular involvement of the pleural fissures, pleural effusion, and volume loss on the more affected side with a fixed mediastinum. They noted most patients had only one radiograph view, which may have restricted the results.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Comparative imaging study (case series) comparing CT with conventional posteroanterior chest radiography, with findings read independently and compared; partly a retrospective re-evaluation
• Who was studied: 27 patients with proved mesothelioma and 13 patients with advanced asbestosis at The Mount Sinai Hospital, New York. Patients with advanced asbestosis and pleural disease were selectively chosen. Radiographs were available for 25 of the mesothelioma patients and CT for all 27; both were available for all 13 asbestosis patients. Study dates are not given.
• Exposure: The article does not report fiber types, jobs or doses for these patients. It states that all mesothelioma patients had underlying asbestosis.
• Main results:
  • Mesothelioma patients: involvement of all pleural compartments, excluding the fissures, was shown by CT in 100% (all 27 patients) and by conventional radiography in 88% (22 of the 25 patients with radiographs).
  • Mesothelioma patients: reduction in volume of the involved side of the chest was seen in 16 patients (65%) on radiographs and 20 patients (74.0%) on CT. Asbestosis patients: it was present in approximately 38% on both methods.
  • Nodules on the more affected side were seen more often on CT than on radiographs: in mesothelioma, 19 patients (70%) versus 13 (52%); in asbestosis, 8 (62%) versus 5 (38%).
  • Asbestosis patients: calcification in pleural plaques was seen on CT in eight (62%) and on plain radiography in only three (23%). Calcified plaques were infrequent in mesothelioma patients.
  • Seven asbestosis patients had irregularly thick, lobular pleural masses that could not be distinguished from mesothelioma by radiography or CT. No malignant transformation was found in any of them by multiple biopsies or surgery.
  • Pleural effusion was not seen in any asbestosis patient. In mesothelioma patients it was seen on radiography in 12 and on CT in only four, because CT was mostly done in the supine (lying on the back) position.
  • Gallium scans were positive in seven of nine mesothelioma patients tested and in one of seven asbestosis patients tested. In that asbestosis patient, a pleural biopsy showed only a hyalinized plaque with an active inflammatory reaction.
• The authors' conclusion: The authors concluded that CT is more efficient than conventional radiography in outlining the features of both asbestosis and mesothelioma. Pleural lesions in advanced asbestosis may also appear as large irregular masses. Features that may help distinguish mesothelioma from advanced asbestosis are nodular involvement of the pleural fissures, pleural effusion, and volume loss on the more affected side with a fixed mediastinum.
• Limitations the authors state:
  • The radiologic examination in most patients was limited to a single posteroanterior exposure, which may have restricted some of the results.
  • The direction of the minor fissure and the narrow section thickness of the CT scanner prevented consistent visualization of the minor fissure on CT.
  • CT was mostly done in the supine position, so it detected fewer pleural effusions than radiography.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Plaques, Pleural Effusion, Mediastinum.

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