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CT Scan Procedure for Lung Cancer Screening in Asbestos-Exposed WorkersScreening CT Scan Procedure FREE TO VIEW

Marie Ollier, MD; Jean-Marc Garcier, MD, PhD; Geraldine Naughton, PhD; Alain Chamoux, MD, PhD; Bruno Pereira, PhD; Frédéric Dutheil, MD, PhD
Author and Funding Information

From the Department of Occupational Medicine (Drs Ollier, Chamoux, and Dutheil) and Department of Radiology (Dr Garcier), Centre Hospitalier Universitaire de Clermont-Ferrand; School of Exercise Science (Drs Naughton and Dutheil), Australian Catholic University; Clinical Research and Innovation Direction (Dr Pereira), Centre Hospitalier Universitaire de Clermont-Ferrand; Laboratory of Molecular Oncology EA 4677 (Dr Ollier), Centre Jean Perrin; Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533 (Dr Dutheil), Université Blaise Pascal; and INRA Unité Mixte de Recherche (UMR) 1019 (Dr Dutheil), Unité de Nutrition Humaine (UNH), CRNH Auvergne, Université d’Auvergne.

CORRESPONDENCE TO: Frédéric Dutheil, MD, PhD, Occupational Medicine, University Hospital CHU G. Montpied, Clermont-Ferrand, France; e-mail: fred_dutheil@yahoo.fr


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):e76-e77. doi:10.1378/chest.14-0831
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Published online
To the Editor:

In a meta-analysis by Ollier et al1 on chest CT scan screening for lung cancer in asbestos-exposed workers in a recent issue of CHEST (June 2014), one source of heterogeneity was omitted: CT scan procedures. Among the seven studies included in the meta-analysis, slice thickness obtained with CT scans was heterogeneous. Not all CT scan procedures in the seven studies used thin slices. Most reported slice thicknesses were ≥ 5 mm. The exceptions described a 1-mm slice thickness but with reconstruction intervals of 10 mm, and another failed to report CT scan parameters (Table 12-8). The importance of the article on lung cancer screening among smokers9 was weakened by a protocol using a 10-mm slice thickness, previously described in the Early Lung Cancer Action Project (ELCAP).10

Table Graphic Jump Location
TABLE 1  ] CT Scan Procedures of the Seven Studies Included in the Meta-analysis of Ollier et al1

rot = rotation.

a 

No direct information on pitch.

Nonetheless, slice thickness has demonstrated improved detection of pulmonary nodules, with an importance of slice thickness reduction below 3 mm for detailed analyses of focal pulmonary abnormalities.11 A retrospective study12 on pulmonary metastasis diagnosis by helical CT scan in slice thicknesses of 3 and 5 mm showed a significant difference in sensitivity of lesion detection and concluded that reducing slice thickness may not only improve treatment and outcome of patients with metastasis, but also increase the rate of false-positive results. These studies did not evaluate the clinical consequences of a higher detection rate of smaller nodules. However, if smaller slice thickness increases false-positive results, we can also expect it will permit earlier detection of lung cancer with a potential for a better prognosis.

We contend that as a part of a low-dose CT scan screening of lung cancer in asbestos-exposed workers, it should be important to also standardize CT scan procedures. A thin-slice study appears to be the optimal CT scan procedure for a systematic screening of lung cancer in asbestos-exposed workers (in addition to the recommended low-dose protocol reconstructed through contiguous images).

References

Ollier M, Chamoux A, Naughton G, Pereira B, Dutheil F. Chest CT scan screening for lung cancer in asbestos occupational exposure: a systematic review and meta-analysis. Chest. 2014;145(6):1339-1346. [CrossRef] [PubMed]
 
Clin B, Morlais F, Guittet L, et al. Performance of chest radiograph and CT scan for lung cancer screening in asbestos exposed workers. Occup Environ Med. 2009;66(8):529-534. [CrossRef] [PubMed]
 
Das M, Mühlenbruch G, Mahnken AH, et al. Asbestos Surveillance Program Aachen (ASPA): initial results from baseline screening for lung cancer in asbestos-exposed high-risk individuals using low-dose multidetector-row CT. Eur Radiol. 2007;17(5):1193-1199. [CrossRef] [PubMed]
 
Fasola G, Belvedere O, Aita M, et al. Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population: baseline results of a prospective, nonrandomized feasibility trial—an Alpeadria Thoracic Oncology Multidisciplinary Group Study (ATOM 002). Oncologist. 2007;12(10):1215-1224. [CrossRef] [PubMed]
 
Mastrangelo G, Ballarin MN, Bellini E, et al. Feasibility of a screening programme for lung cancer in former asbestos workers. Occup Med (Lond). 2008;58(3):175-180. [CrossRef] [PubMed]
 
Roberts HC, Patsios DA, Paul NS, et al. Screening for malignant pleural mesothelioma and lung cancer in individuals with a history of asbestos exposure. J Thorac Oncol. 2009;4(5):620-628. [CrossRef] [PubMed]
 
Tiitola M, Kivisaari L, Huuskonen MS, et al. Computed tomography screening for lung cancer in asbestos-exposed workers. Lung Cancer. 2002;35(1):17-22. [CrossRef] [PubMed]
 
Vierikko T, Järvenpää R, Autti T, et al. Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings. Eur Respir J. 2007;29(1):78-84. [CrossRef] [PubMed]
 
National Lung Screening Trial Research Team;Aberle DR, Berg CD, Black WC, et al. The National Lung Screening Trial: overview and study design. Radiology. 2011;258(1):243-253. [CrossRef] [PubMed]
 
Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet. 1999;354(9173):99-105. [CrossRef] [PubMed]
 
Paranjpe DV, Bergin CJ. Spiral CT of the lungs: optimal technique and resolution compared with conventional CT. AJR Am J Roentgenol. 1994;162(3):561-567. [CrossRef] [PubMed]
 
Pfannschmidt J, Bischoff M, Muley T, et al. Diagnosis of pulmonary metastases with helical CT: the effect of imaging techniques. Thorac Cardiovasc Surg. 2008;56(8):471-475. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
TABLE 1  ] CT Scan Procedures of the Seven Studies Included in the Meta-analysis of Ollier et al1

rot = rotation.

a 

No direct information on pitch.

References

Ollier M, Chamoux A, Naughton G, Pereira B, Dutheil F. Chest CT scan screening for lung cancer in asbestos occupational exposure: a systematic review and meta-analysis. Chest. 2014;145(6):1339-1346. [CrossRef] [PubMed]
 
Clin B, Morlais F, Guittet L, et al. Performance of chest radiograph and CT scan for lung cancer screening in asbestos exposed workers. Occup Environ Med. 2009;66(8):529-534. [CrossRef] [PubMed]
 
Das M, Mühlenbruch G, Mahnken AH, et al. Asbestos Surveillance Program Aachen (ASPA): initial results from baseline screening for lung cancer in asbestos-exposed high-risk individuals using low-dose multidetector-row CT. Eur Radiol. 2007;17(5):1193-1199. [CrossRef] [PubMed]
 
Fasola G, Belvedere O, Aita M, et al. Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population: baseline results of a prospective, nonrandomized feasibility trial—an Alpeadria Thoracic Oncology Multidisciplinary Group Study (ATOM 002). Oncologist. 2007;12(10):1215-1224. [CrossRef] [PubMed]
 
Mastrangelo G, Ballarin MN, Bellini E, et al. Feasibility of a screening programme for lung cancer in former asbestos workers. Occup Med (Lond). 2008;58(3):175-180. [CrossRef] [PubMed]
 
Roberts HC, Patsios DA, Paul NS, et al. Screening for malignant pleural mesothelioma and lung cancer in individuals with a history of asbestos exposure. J Thorac Oncol. 2009;4(5):620-628. [CrossRef] [PubMed]
 
Tiitola M, Kivisaari L, Huuskonen MS, et al. Computed tomography screening for lung cancer in asbestos-exposed workers. Lung Cancer. 2002;35(1):17-22. [CrossRef] [PubMed]
 
Vierikko T, Järvenpää R, Autti T, et al. Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings. Eur Respir J. 2007;29(1):78-84. [CrossRef] [PubMed]
 
National Lung Screening Trial Research Team;Aberle DR, Berg CD, Black WC, et al. The National Lung Screening Trial: overview and study design. Radiology. 2011;258(1):243-253. [CrossRef] [PubMed]
 
Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet. 1999;354(9173):99-105. [CrossRef] [PubMed]
 
Paranjpe DV, Bergin CJ. Spiral CT of the lungs: optimal technique and resolution compared with conventional CT. AJR Am J Roentgenol. 1994;162(3):561-567. [CrossRef] [PubMed]
 
Pfannschmidt J, Bischoff M, Muley T, et al. Diagnosis of pulmonary metastases with helical CT: the effect of imaging techniques. Thorac Cardiovasc Surg. 2008;56(8):471-475. [CrossRef] [PubMed]
 
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