Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature

Our plain-English summary of Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature, by D.N. Weissman (Seminars in Respiratory and Critical Care Medicine, 2015).

The study

• Author: D.N. Weissman
• Journal: Seminars in Respiratory and Critical Care Medicine
• Published: 2015;36(3):433-48
• Type of article: Review
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This review provides an update on literature published over the past 5 years that is relevant to using chest computed tomography (CT) as a tool for preventing occupational respiratory disease. An important area of investigation has been in the use of low-dose CT (LDCT) to screen asbestos-exposed populations for lung cancer. Two recent systematic reviews have reached conclusions in support of screening. Based on the limited evidence that is currently available, the Finnish Institute of Occupational Health has recommended LDCT screening in asbestos-exposed individuals if their personal combination of risk factors yields a risk for lung cancer equal to that needed for entry into the National Lung Screening Trial. It has also recommended further research, such as to document the optimal frequency of screening and the effectiveness of screening. Recent literature continues to support high-resolution CT (HRCT) as being more sensitive than chest radiography in detecting pneumoconiosis. However, there are insufficient data to determine the effectiveness of HRCT screening in improving individual outcomes if used in screening for pneumoconiosis and its routine use for this purpose cannot be recommended. However, if HRCT is used to evaluate populations, recent literature shows that the International Classification of HRCT for Occupational and Environmental Respiratory Diseases provides an important tool for reproducible evaluation and recording of findings. HRCT is an important tool for individual patient management and recent literature has documented that chest HRCT findings are significantly associated with outcomes such as pulmonary function and mortality.

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In plain English

This article was a review, not a new study. The author searched PubMed in September 2014 for articles entered from January 2009 on chest computed tomography (CT) and occupational lung or pleural disease. The author selected 65 English-language articles and added others found in reference lists. The review described two systematic reviews of low-dose CT screening for lung cancer in asbestos-exposed workers. In one, a meta-analysis, lung cancer was detected at a prevalence of 1.1% (95% confidence interval 0.6 to 1.8%). Both reached conclusions in support of screening, though one described the underlying studies as case series with limited numbers of subjects and no control groups. The Finnish Institute of Occupational Health recommended screening asbestos-exposed people whose risk equalled that needed to enter the National Lung Screening Trial. In one follow-up study the review described, pleural plaques seen on CT were a risk factor for pleural mesothelioma. The author concluded that high-resolution CT is more sensitive than chest X-ray for pneumoconiosis. However, there were insufficient data on whether it improves outcomes, so routine screening for pneumoconiosis could not be recommended.

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: Literature review (non-systematic) of articles found by a PubMed search, supplemented by articles from reference lists or known to the author
• Who was studied: 65 English-language articles selected from 269 found in PubMed (January 2009 to September 10, 2014): 47 original investigations, 17 reviews and 1 proceeding report, plus added articles
• Exposure: Use of chest CT in workers exposed to occupational carcinogens such as asbestos (lung cancer screening) and to dusts such as silica and coal mine dust (nonmalignant disease such as pneumoconiosis)
• Main results:
  • In a systematic review and meta-analysis by Ollier et al of low-dose CT screening in asbestos-exposed workers, lung cancer was detected with a prevalence of 1.1% (95% confidence interval 0.6 to 1.8%)
  • Two recent systematic reviews reached conclusions in support of lung cancer screening of asbestos-exposed populations with low-dose CT
  • The Finnish Institute of Occupational Health recommended low-dose CT screening for asbestos-exposed individuals whose combined risk factors give a lung cancer risk equal to that needed to enter the National Lung Screening Trial
  • In a reviewed follow-up study of men with previous occupational asbestos exposure (Pairon et al 2013), pleural plaque seen on CT was a risk factor for incident pleural mesothelioma
  • In a reviewed study of 2,743 previously asbestos-exposed subjects (Clin et al 2011), parietal and/or diaphragmatic pleural plaques were related to small but statistically significant decreases in lung function measures
  • In a reviewed meta-analysis of lung function in asbestos-exposed workers (Wilken et al 2011), lung function impairments were less severe when diagnoses were based on high-resolution CT than on plain chest images
  • In a reading trial of the ICOERD classification for high-resolution CT, readers showed moderate-to-good agreement for all areas except ground glass opacities
  • The author stated that high-resolution CT is more sensitive than chest radiography for detecting pneumoconiosis
• The authors' conclusion: The author concluded that, although high-resolution CT is more sensitive than chest radiography for pneumoconiosis, there are insufficient data on its effect on individual outcomes, and it cannot currently be recommended for pneumoconiosis screening.
• Limitations the authors state:
  • The studies of lung cancer screening in asbestos-exposed workers were described as case series with limited numbers of subjects, no control groups and little follow-up data on mortality
  • There is not a comparable body of data showing that early detection of pneumoconiosis through screening improves outcome

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Systematic Review, Low-Dose CT Screening, High-Resolution CT (HRCT), Pneumoconiosis.

Related studies

• Relationships (I) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with the ILO International Classification of Radiographs of Pneumoconioses for parenchymal abnormalities — T. Tamura, N. Suganuma, et al. (2015)
• Computer-assisted classification system for chest X-ray and computed tomography findings in occupational lung disease — T. Kraus, H.J. Raithel, et al. (1997)
• Psychological impact of computed tomography screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers — T. Vierikko, S. Kivistö, et al. (2009)
• The usefulness of computed tomography in detecting asbestos-related pleural abnormalities in people who had indeterminate chest radiographs: the Libby, MT, experience — O.I. Muravov, W.E. Kaye, et al. (2005)
• Occupational respiratory disease in mining — M.H. Ross, J. Murray (2004)
• Nonmalignant respiratory disease mortality among woodworkers participating in the American Cancer Society Cancer Prevention Study-II (CPS-II) — P.A. Demers, S.D. Stellman, et al. (1998)

Browse more research in Seminars in Respiratory and Critical Care Medicine, or return to medical research.