Beningn ARD

The presentation and natural history of

asbestos-induced diffuse pleural
thickening
Occup Med (Lond). 2012 Jun;62(4):266-8.

Jeebun V, Stenton SC.

There are three forms of asbestos-related benign pleural disease are recognized:
discrete pleural plaques, pleural effusions and diffuse pleural fibrosis. Of these, diffuse
pleural fibrosis is the most significant on account of its chronicity and associated
morbidity. Diffuse pleural fibrosis was considered to be present if there was obliteration
of the costophrenic angle in continuity with at least 3-mm pleural thickening, in
accordance with the International Labour Organization 2000 Classification.

The median latency for development of diffuse pleural fibrosis from first asbestos
exposure was 34 years. Seventy-three per cent of patients had unilateral disease at
presentation and 24% of these were observed to develop contralateral disease after a
median of 2 years. Unilateral pleural disease was commonest on the right. Forty per
cent of patients presented with pleural effusions preceding the development of diffuse
pleural thickening. The median latency for development of pleural effusions from onset
of exposures was 38 years. Eighty per cent of the pleural effusions were unilateral.
Once established, pleural thickening was reported to have remained stable in 91% on
the ipsilateral side

3T MRI in evaluation of asbestos-related thoracic diseases -

preliminary results.
Podobnik J, Kocijancic I, Kovac V, Sersa I.

Radiol Oncol. 2010 Jun;44(2):92-6

In slovenia, These preliminary results pointed out that MRI was equal or even better compared with
CT examination for detecting possible malignant potential of pleural changes in the asbestos-
related pleural disease, using signal intensity measurements of T2 fs-weighted images. The 3T MRI
enabled the accurate determination of chest pathology and it could be used for imaging of patients
with the asbestos-related thoracic disease. MRI is particularly valuable because a patient is not
exposed to the harmful radiation which is important if imaging methods are used repeatedly, like in
screening programs or in monitoring of treatment results. This finding turned us to propose 3T MRI
imaging technique as a non-ionizing imaging method for the follow-up of patients with the isolated
pleural form of the asbestos-related disease.

Asbestosis
[Incidence of asbestosis and other benign lung diseases:
Spain, 1962-2010].
Garca Gmez M, Menndez-Navarro A, Castaeda Lpez R.

Rev Esp Salud Publica. 2012 Dec;86(6):613-25.

Between 1963 and 2010, 815 cases of asbestosis and 46 cases of fibrous pleural or
pericardial disease were recognized. Since 1990 until 2001 Fiber-cement sector accumulated 189
cases of asbestosis, Shipbuilding sector 173, Construction sector 49 and Metallurgy 35. By
occupation, fixed machinery operators had 114 cases; in molders, welders, sheet metal workers and
fitters 88 cases; and painters, plumbers and pipe fitters 59 cases.

Mortality from asbestosis and mesothelioma in Britain by birth

cohort.
Occup Med (Lond). 2012 October; 62(7): 549552.

Andrew Darnton,1 John Hodgson,1 Paul Benson,1 and David Coggon2

Analysis of occupational mortality in England and Wales during 1991-2000 showed no decline in
work-attributable deaths from asbestosis.

Our findings suggest that in time, mortality in Great Britain from both asbestosis and
mesothelioma can be expected to decline at even the oldest ages, the reduction for
asbestosis occurring a little earlier than that for mesothelioma. However, because death
rates from both diseases increase steeply with age and largely reflect exposures early in
working life, it will be many years before we can be confident that controls on
occupational exposure to asbestos have fully eliminated the risks associated with the
mineral.

Controls on asbestos exposure in the UK started to have major impact in the 1970s, when
the birth cohort with highest death rates from mesothelioma would have been in their
thirties.

Controls on exposure appear to have had little impact on older workers who had already
accumulated higher exposures during their first few decades of work.

Multimodality therapy for malignant pleural

mesothelioma

Walter Weder and Isabelle Opitz

Ann Cardiothorac Surg. 2012 November; 1(4): 502507.

Patients with histologically proven mesothelioma and resectable tumor load who could
tolerate the different treatment modalities (including surgery) should be considered for a
multimodal approach and be included in a trial whenever possible.
Malignant pleural mesothelioma: an epidemiological
perspective.
Benjamin M. Robinson
Ann Cardiothorac Surg. 2012 November; 1(4): 491496.

Pleural mesothelioma is the most common of these, accounting for approximately 90%
of disease (1,2). Patients commonly present with dyspnoea, chest wall pain and pleural
effusion (3). Diagnosis is often made at an advance stage of disease and in untreated
patients median survival is less than one year

Asbestos exposure is the most thoroughly established risk factor for malignant mesothelioma.

Disease incidence varies markedly within and between countries. The highest annual rates of
disease, approximately 30 case per million, are reported in Australia and Great Britain. The risk of
disease increases with age and is higher in men. Time from asbestos exposure to disease diagnosis
is on average greater than 40 years.

In Australia, male diagnoses dominate and more than 75% of newly diagnosed patients
are aged 65 years or older.

Semin Oncol. 2002 Feb;29(1):41-50.

Multimodality treatment of diffuse malignant pleural

mesothelioma.
Zellos LS, Sugarbaker DJ.

Diffuse malignant pleural mesothelioma (DMPM) is a challenging disease in all of its aspects, from
presentation and diagnosis to staging and treatment. Single-modality therapy was the initial approach
to this disease. It generally has not been effective in changing the natural history of DMPM. As a
result, multimodality regimens involving surgery with radiation, chemotherapy, or immunotherapy
delivered regionally or systemically have been evaluated. Randomized controlled studies comparing
various strategies are lacking and, thus, the debate continues regarding the effectiveness of different
treatment approaches.

Multimodal therapy of malignant pleural mesothelioma: is the

replacement of radical surgery imminent?
Lindenmann J, Matzi V, Neuboeck N, Anegg U, Maier A, Smolle J, Smolle-Juettner FM.

Interact Cardiovasc Thorac Surg. 2013 Mar;16(3):237-43

Malignant pleural mesothelioma (MPM) remains an aggressive thoracic malignancy associated with
poor prognosis. There is no standard treatment regimen,