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LDCT Evaluated for Early Diagnosis of Lung Cancer and Mesothelioma

According to a recent and promising study in The Oncologist, researchers found that LDCT (Low Dose Computed Tomography) may be helpful in detecting pleural abnormalities including the early diagnosis of malignant pleural cancer and mesothelioma. Researchers evaluated LDCT, i.e., spiral or helical computed tomography, screening of those exposed to asbestos. LDCT proved more effective at early detection of lung cancer than a chest radiograph (x–ray).

Mesothelioma and Lung Cancer Study’s Objective in Evaluating LDCT Screening

The objective of the study was to create a nonrandomized trial to evaluate the feasibility of baseline and annual repeat screening using LDCT for the early diagnosis of lung cancer and malignant pleural mesothelioma in a population that had been exposed to asbestos. 1,045 volunteers, already enrolled in a surveillance program for asbestos–exposed workers and former workers, were recruited for the study. The volunteers, between the age of 40–75, had no history of prior cancer, or other severe, preexisting conditions and no chest CT scan in the last two years.

Participants underwent a structured interview regarding their medical and occupational history, including their involvement with asbestos. Researchers determined that the median age was 58 years, with an average amount of time exposed to asbestos of 30 years. Most participants, sixty–six percent, had smoked for almost 20 years.

After participants were screened, blood samples were taken and they were given respiratory tests, a chest x–ray and an initial LDCT screening. All LDCT images were reviewed by two radiologists and their findings were individually recorded, discussed and documented. In many participants, LDCT revealed nodules on their lungs, round or oval–shaped lesions, both benign and malignant. The nodules were identified and classified into categories. Positive baseline results were defined as noncalcified nodules (enlarged nodules that may be malignant) and pleural thickening (a hardening of the lungs). Participants with positive findings received a high–resolution CT–scan and additional diagnostic tests. If the nodule was not benign, it was treated by a CT–guided biopsy and video–assisted thoracoscopic surgery, or by a bronchoscopy—a procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope.

LDCT Screening Results

834 noncalcified (benign) nodules were detected in 44% of the participants on an initial LDCT compared to 43 noncalcified nodules in 4% of participants by chest x–ray.
There were nine cases of lung cancer detected by LDCT and none by chest x–ray. Of the nine lung cancers detected, eight lung cancers were Stage I and one was Stage IIA. All were treated with potentially curative surgery.
In addition, one person had a thymic carcinoid detected by LDCT. There were 11 false positive results.
(The Oncologist, August 21, 2007)

It was determined that “annual repeat LDCT screening could provide useful information on the natural history and significance of asbestos–related pleural abnormalities.” Researchers concluded that LDCT “significantly increases the likelihood of detecting small nodules, and thus lung cancer, at an earlier, more curable stage.” (The Oncologist, August 21, 2007) LDCT was 19 times more likely to detect nodules than the x–ray, and none of the malignant nodules were detected by x–ray.

LDCT’s sensitivity for detecting lung cancer is four times greater than the sensitivity of an x–ray. (American Family Physician, March 15, 2005) The assumption is that a 5– to 10–mm nodule found by LDCT is more curable than a 2– to 3–cm lesion seen on chest radiographs. (American Journal of Respiratory and Critical Care Medicine, March, 2001) “... It is reasonable to expect that novel insights into the significance of pleural abnormalities may emerge from novel imaging techniques with higher resolution capabilities than 5–mm collimation CT.” (The Oncologist, August 21, 2007)

Although no cases of mesothelioma were detected in this study usingLDCT, a very high number of pleural abnormalities were detected. Imaging is crucial in the diagnosis of mesothelioma. X–rays of the pleura (lining of the lungs) are used to show lung abnormalities such as pleural effusions (excess fluid between the two membranes that envelops the lungs) and pleural thickening which are symptoms of mesothelioma. Further clinical trials are necessary to evaluate the possibilities of using LDCT to detect and diagnose mesothelioma.

MESOMARK BLOOD TEST
In January 2007, the Food and Drug Administration (FDA) approved the MESOMARK assay to help monitor response to treatment in malignant mesothelioma patients. The MESOMARK test signifies the beginning of a new era in monitoring mesothelioma malignancies," said Dr. W. Jeffrey Allard, vice president and chief scientific officer of Fujirebio Diagnostics. "As the first in-vitro test for patients with this aggressive disease, it will enable doctors to more accurately detect recurrence and monitor treatment of patients."
Learn more about Mesomark Blood Test

Steve McQueen's Mesothelioma Diagnosis

Many are aware that famous movie actor, Steve McQueen, died of cancer. But few are aware he actually had a mesothelioma diagnosis. As most are also not aware, Steve McQueen worked in a shipyard as a young man where he was likely exposed to asbestos.
Steve McQueen mesothelioma diagnosis video