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LCDT voor vroeg-ontdekking asbestgerelateerde longkanker

29-11-2007 00:00

Een lage dosis spiraal-CT scan (low-dose computed tomography screening) kan helpen bij het in een vroeg stadium ontdekken van longkanker bij mensen die met asbest hebben gewerkt. Bij de ziekte mesothelioom is de werking van deze techniek nog niet duidelijk. Computertomografie is onderzoek waarbij met r&öntgenstralen zeer gedetailleerde dwarsdoorsnedes van het lichaam zichtbaar gemaakt worden op een beeldscherm. Bron: Fasola, G., et al., (2007). Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population. The Oncologist 12, 1215-1224.

Fasola, G., et al., (2007). 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 Alpe-adria Thoracic Oncology Multidisciplinary Group Study (ATOM 002). The Oncologist 12, 1215-1224.
ABSTRACT
OBJECTIVE:
To evaluate the feasibility of using low-dose computed tomography (LDCT) for the early diagnosis of lung cancer and malignant pleural mesothelioma in an asbestos-exposed population.

METHODS: Between February 2002 and October 2003, 1,045 volunteers already enrolled in a surveillance program for asbestos-exposed workers and former workers were recruited. The main eligibility criteria were: written informed consent, definite exposure to asbestos, age 40-75, no prior cancer or severe concomitant conditions, no chest CT scan in the past 2 years. A smoking history was not required. After a structured interview, chest X-ray (CXR) and LDCT were performed. Participants with negative examinations were assigned to annual LDCT. Participants with positive findings received high-resolution CT and additional diagnostic workup as appropriate.

RESULTS: Baseline characteristics of the screened population were: median asbestos exposure time, 30 years. median age, 58. median pack-years in smokers/former smokers, 18.5. Thirty-four percent had never smoked. On LDCT, 834 noncalcified nodules were identified in 44% of participants, versus 43 nodules in 4% on CXR. Pleural abnormalities were observed in 44% and 70% of participants by CXR and LDCT, respectively. Overall, LDCT identified nine cases of non-small cell lung cancer-eight stage I, one stage IIA-and one thymic carcinoid, corresponding to 1% of the enrolled population. All cases were radically treated. None had been detected by CXR. No pleural mesothelioma was diagnosed. There were 11 false-positive results.

CONCLUSIONS: Our findings first suggest that LDCT may be at least as useful in asbestos workers as in heavy smokers for the early diagnosis of lung cancer. this benefit is evident even in a poor-risk population, with low rates of smoking prevalence and a previous history of radiological surveillance. The role of spiral tomography in screening for pleural mesothelioma remains uncertain.