Gallium scanning in differentiating malignant from benign asbestos-related pleural disease

Our plain-English summary of Gallium scanning in differentiating malignant from benign asbestos-related pleural disease, by A.S. Teirstein, P. Chahinian, S.J. Goldsmith, et al (American Journal of Industrial Medicine, 1986).

The study

• Authors: A.S. Teirstein, P. Chahinian, S.J. Goldsmith, M. Sorek
• Journal: American Journal of Industrial Medicine
• Published: 1986;9(5):487-94
• Cited by: 7 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. 001146).

Abstract

In order to assess the utility of 67gallium citrate in delineating malignant pleural mesothelioma from benign asbestos-related pleural disease, 49 patients with malignant mesothelioma and 16 with benign asbestos-related pleural disease were studied. Seven patients with malignant mesothelioma had no history of asbestos exposure, while the remaining 58 patients were exposed. Forty-three of the 49 patients (88%) with malignant mesothelioma had a positive 67gallium scan including 36 of the 42 (86%) patients with asbestos exposure and all 7 patients without a history of asbestos exposure. Three of 16 patients (19%) with benign asbestos-related pleural disease had a positive scan. 67Gallium radionuclide imaging is nonspecific but may be valuable in noninvasive monitoring of asbestos-exposed populations, which have a high risk for the late development of benign and/or malignant pleural disease.

In plain English

This study tested whether gallium-67 citrate scanning could tell malignant mesothelioma apart from benign asbestos-related pleural disease. It included 65 patients. Forty-nine had malignant mesothelioma, and 7 of these had no history of asbestos exposure. Sixteen had benign asbestos-related pleural disease, such as pleural thickening, pleural calcification or pleural plaques. A panel of three investigators read the scans without knowing the patients' clinical or X-ray findings. Scans were positive in 43 of the 49 mesothelioma patients (88%). This included 36 of the 42 asbestos-exposed patients (86%) and all 7 patients with no history of exposure. Scans were also positive in 3 of the 16 patients with benign disease (19%), and tissue removed from these three showed a strong inflammatory reaction. Among asbestos-exposed patients, the scan's sensitivity was 86% and its specificity 81%. The authors concluded that gallium scanning is nonspecific and that neither a positive nor a negative scan is diagnostic. They added that it may be useful alongside other techniques for monitoring asbestos-exposed populations.

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: Diagnostic study comparing gallium-67 citrate scan results in patients with malignant mesothelioma and patients with benign asbestos-related pleural disease. Scans were read by a panel that did not know the patients' clinical or radiographic findings.
• Who was studied: 65 patients with pleural disease. 49 had malignant mesothelioma (7 with no history of asbestos exposure), diagnosed by closed pleural biopsy or open thoracotomy. 16 had benign asbestos-related pleural disease (bilateral pleural thickening, pleural calcification and/or pleural plaques). The authors were at The Mount Sinai Medical Center and Brookdale Hospital Medical Center, New York. The study period is not stated.
• Exposure: History of asbestos exposure. Fiber types and doses are not given. 58 patients were exposed; 7 mesothelioma patients had no exposure history. Examples given are a former shipyard worker and a man who worked 20 years in an asbestos insulation factory.
• Main results:
  • Malignant mesothelioma patients: 43 of 49 (88%) had positive gallium-67 scans, including 36 of the 42 asbestos-exposed patients (86%).
  • All 7 mesothelioma patients with no history of asbestos exposure had positive scans.
  • The 6 mesothelioma patients with negative scans did not differ in clinical, pathologic cell type or radiographic presentation from the 43 with positive scans.
  • Benign asbestos-related pleural disease: 13 of 16 patients (81%) had negative scans and 3 (19%) had positive scans.
  • The 3 benign-disease patients with positive scans underwent thoracotomy, and their resected tissue showed exuberant inflammatory reaction.
  • In asbestos-exposed patients, sensitivity of gallium-67 scanning for malignant mesothelioma was 86% and specificity was 81%.
• The authors' conclusion: The authors concluded that gallium-67 scanning is nonspecific in differentiating benign from malignant asbestos-related pleural disease and that neither a positive nor a negative scan is diagnostic. They said results must be combined with clinical, radiographic and laboratory data, and that the scan may be useful as an adjunct in monitoring asbestos-exposed populations.

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: Asbestos-Related Pleural Disease, Pleural Mesothelioma, Malignant Mesothelioma, Asbestos Exposure.

Related studies

• Gallium scanning in peritoneal mesothelioma — R.R. Armas, S.J. Goldsmith (1985)
• Bronchoalveolar lavage analysis, gallium-67 lung scanning and soluble interleukin-2 receptor levels in asbestos exposure — G.L. Delclos, D.G. Flitcraft, et al. (1989)
• Unexpected gallium uptake in benign pulmonary pathology. Report of two cases — R.G. McLean, D. Choy, et al. (1984)
• Pulmonary uptake of gallium-67 in asbestos-exposed humans and sheep — R. Bégin, A. Cantin, et al. (1983)
• Gallium-67 citrate imaging studies of the lung — C. Bekerman, P.B. Hoffer, et al. (1980)
• Multiplane gallium tomography in assessment of occupational chest diseases — E.M. Cordasco, J. O'Donnell, et al. (1990)

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