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Kim, Kim, and Kim: Radiologic Diagnosis of Asbestos-Related Lung Cancer
Chest Radiology

Journal of the Korean Society of Radiology 2015; 73(6): 347-356.

Published online: 3 December 2015

DOI: https://doi.org/10.3348/jksr.2015.73.6.347

Radiologic Diagnosis of Asbestos-Related Lung Cancer

Yoon Kyung Kim, MD1, Jeung Sook Kim, MD2, Yookyung Kim, MD3

1Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea.

2Department of Radiology, Dongguk University Ilsan Hospital, Goyang, Korea.

3Department of Radiology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Jeung Sook Kim, MD. Department of Radiology, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea. Tel. 82-31-961-7823, Fax. 82-31-961-8281, jeungkim@dumc.or.kr

Received 15 April 2015       Revised 1 June 2015       Accepted 14 July 2015

Copyright © 2015 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Asbestos was previously widely used due to its many favorable characteristics, such as durability, flexibility, and inexpensiveness. Asbestos has been prohibited in Korea since 2009, however, asbestos-related diseases remain an important public health issue because of its long latency time. Lung cancer is one of the most harmful asbestos-related diseases and patients with asbestos-related lung cancer receive compensation by law. The diagnosis of asbestos-related diseases is based on a detailed interview regarding the asbestos exposure, in addition to clinical, radiological, pathological, and laboratory data. This review provides a radiologic diagnosis of asbestos-related lung cancer.

Keywords: Lung Cancer, Asbestos, CT

Figures and Tables

Fig. 1

Representative CT images of asbestosis; specific (A-C) and nonspecific (D-F) findings.

A. Subpleural dot-like and branching opacities.
B. Subpleural curvilinear opacities.
C. Parenchymal band.
D. Intralobular interstitial thickening (arrows).
E. Intralobular interstitial thickening (arrows) and interlobular septal thickening.
F. Honeycombing.
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Fig. 2

Representative CT images of pleural plaque.

A. Multiple bilateral plaques.
B. Diaphragmatic pleural plaques.
C. Noncalcified plaque (arrows).
D. Thin plaque (arrows).
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Fig. 3

A 67-year-old male who had been a slate factory worker for 20 years.

Chest PA (A) and lateral (B) views show a mass in the left middle lung zone. Pleural plaques (arrows) are seen along the right lateral chest wall and diaphragmatic pleura. Axial (C) and coronal (D) CT images show a lobulated mass with heterogeneous enhancement in left upper lobe and pleural plaques (arrows) in both hemithoraces. The mass was diagnosed as squamous cell carcinoma by percutaneous needle biopsy.
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Fig. 4

A 74-year-old male who had been asbestos mine worker for 5 years and resided near the asbestos mine for 27 years.

Forty-four years after his initial exposure to asbestos, large cell neuroendocrine carcinoma developed in the right middle lobe (A). Calcified pleural plaques are seen in both hemithoraces and diaphragms (A, B). On lung window setting images (C-E), parenchymal bands and intralobular interstitial thickening suggestive of asbestosis (arrows) are noted adjacent the plaques.
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Fig. 5

A 55-year-old male with squamous cell carcinoma in the left upper lobe.

He was a construction worker for 24 years. Coronal reformatted image (A) shows a mass suggestive of lung cancer in the left upper lobe. Axial images (B, C) show honeycombing in both subpleural lungs, predominantly in the lower lung zones. In the area of less severe fibrosis, subpleural dot-like opacities, suggestive of early findings of asbestosis, are seen (arrows).
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Table 1

Helsinki Criteria for Evaluating Asbestos Related Lung Cancer

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1. The presence of asbestosis (e.g., asbestosis diagnosed clinically, radiologically using high-resolution CT or histologically).
2. A count of 5000 to 15000 asbestos bodies (ABs) or more per gram of dry lung tissue (/g dry), or an equivalent uncoated fiber burden of 2.0 million or more amphibole fibers (> 5 µm in length)/g dry, or 5.0 million or more amphibole fibers > 1 µm in length/g dry; this tissue count of ABs is also roughly equivalent to 5-15 ABs/mL of bronchoalveolar lavage (BAL) fluid.
3. Estimated cumulative exposure to asbestos of 25 fiber-years or more.
4. An occupational history, the only means whereby latency can be evaluated, of 1 year of heavy exposure to asbestos (e.g., manufacture of asbestos products, asbestos spraying, insulation work with asbestos materials, demolition of old buildings) or 5-10 years of moderate exposure (e.g., construction or shipbuilding). The criteria go on to state that a 2-fold risk of lung cancer can be reached with exposures less than 1 year in duration if the exposure is of extremely high intensity (e.g., spraying of asbestos insulation materials).
5. A minimum lag-time of 10 years.

Criteria for acceptance: one of (1-4) and 5

Table 2

Criteria for Acceptance of Asbestos Related Lung Cancer in Asbestos Damage Relief Act in Korea

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A. In any of the following events
 1) A biopsy and microscopic examination
 2) Clinical and radiological evaluation (in case of no availability of biopsy and microscopic examination)
B. If medical decision falls within any of sections 1-3
 1) Asbestosis
 2) Pleural plaque
 3) Asbestos bodies or fibers in dry lung or bronchoalveolar lavage fluid

Criteria for acceptance: 1 and 2.

1 = A and B, 2 = latency and substantial exposure

Table 3

Radiologic Diagnostic Guideline of Asbestos-Related Lung Cancer

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Pleural Plaque Asbestosis Approval
Specific Specific Approval
Nonspecific fibrosis Approval
None Approval
Equivocal Specific Approval
Nonspecific fibrosis Refer to exposure history
None Refer to exposure history
None Specific Approval
Nonspecific fibrosis Refer to exposure history
None Refer to exposure history

Acknowledgments

This research was supported by the Korea Ministry of Environment under 'The Environmental Health Action program'.

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