Screening for Malignant Pleural Mesothelioma and Lung Cancer in Individuals with a History of Asbestos Exposure Heidi C. Roberts, MD, Demetris A. Patsios,

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Screening for Malignant Pleural Mesothelioma and Lung Cancer in Individuals with a History of Asbestos Exposure Heidi C. Roberts, MD, Demetris A. Patsios, MD, Narinder S. Paul, MD, Marc dePerrot, MD, Warren Teel, MD, Hamid Bayanati, MD, Frances Shepherd, MD, Michael R. Johnston, MD Journal of Thoracic Oncology Volume 4, Issue 5, Pages 620-628 (May 2009) DOI: 10.1097/JTO.0b013e31819f2e0e Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Overview of the follow up and outcome of the study participants following the baseline study and the annual repeat study. PP, pleural plaques; MPM, malignant pleural mesotheliomas; f/u, follow-up. Journal of Thoracic Oncology 2009 4, 620-628DOI: (10.1097/JTO.0b013e31819f2e0e) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 A, low-dose computed tomography (LDCT) images from different study participants. Post prior asbestos exposure, evidence of flat, partly calcified pleural plaques along the costal pleural surface (arrow). B, Post prior asbestos exposure, evidence of lobulated pleural plaques along the costal pleural surface, without calcifications (arrow). Journal of Thoracic Oncology 2009 4, 620-628DOI: (10.1097/JTO.0b013e31819f2e0e) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Baseline low-dose computed tomography (LCDT) (left) of a 64-year-old male shows a hypoattenuated/necrotic mass along the right pleura/diaphragm (arrows), which is better visualized on the subsequent contrast-enhanced computed tomography (CT) (right). Biopsy revealed a malignant mesothelioma. Journal of Thoracic Oncology 2009 4, 620-628DOI: (10.1097/JTO.0b013e31819f2e0e) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Annual repeat screening low-dose computed tomography (LDCT) of a 68-year-old man. The annual repeat demonstrates intra-abdominal, prehepatic soft tissue nodules which were not present on the baseline. Subsequent investigations revealed a malignant peritoneal mesothelioma. Journal of Thoracic Oncology 2009 4, 620-628DOI: (10.1097/JTO.0b013e31819f2e0e) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 A, Baseline low-dose computed tomography (LDCT) of a 71-year-old man demonstrated asymmetric pleural plaques, right dominant (arrow). A 3 months follow-up was recommended. B, Three months later, there is interval development of a moderate pleural effusion (asterisk), (C) as well as new nodules along the pleural surface (arrow). Subsequent thoracocentesis and drainage to dryness was positive for mesothelioma. D, The contrast-enhanced staging computed tomography (CT) 2 months later showed recurrence of the pleural effusion, increase in the previously seen pleural effusions as well as new soft tissue nodules along the mediastinal surface and along the azygos lobe (arrow). Journal of Thoracic Oncology 2009 4, 620-628DOI: (10.1097/JTO.0b013e31819f2e0e) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions