Introduction There is a lack of recent evidence in terms of progression and prognosis in subjects with asbestos induced diffuse pleural thickening (DPT). We reviewed those with a diagnosis of DPT to look at radiological progression and prognosis.
Methods A local database search identified those registered with DPT as agreed by a Multidisciplinary Meeting (MDT) and defined by Industrial Injuries Disablement Benefit (IIDB) as including obliteration of a costophrenic angle on chest x-ray (CXR) and mesothelioma previously ruled out. Years of follow-up and progression on radiology defined as a measureable increase in thickening unilaterally on CXR, or new obliteration of a costophrenic angle contralaterally. All causes of death were recorded.
Results 39 of 48 subjects registered, all male had local follow up. Radiological follow-up occurred for between 1 and 10 years, mean 3.9 yrs.
In total 16/39 (41%) had radiological progression on CXR. 7 (18%) died, 6/39 (15%) from respiratory related illness. 6/39 had coexistent asbestosis.
28/39 (72%) presented with unilateral DPT of whom 5/28 (18%) had asbestosis on CT.
11/28 (39%) progressed from unilateral to bilateral DPT including 3 with asbestosis, 4/28 (14%) died, (1 with DPT and asbestosis developed mesothelioma), 1of non-respiratory cancer, 2 died respiratory failure; however 35% (8/23) of the unilateral DPT only cohort also progressed or died.
5/11 (45%) presenting with bilateral DPT progressed or died. 2 (18%) increased thickening on CXR. 3/11 (27%) died, 1 lung cancer (with asbestosis) and 2 respiratory failure.
Discussion Although DPT is considered benign, 41% progressed including 39% with unilateral DPT who developed bilateral disease. 15% had coexistent asbestosis and as expected were more likely to progress or die. 11% of those presenting with unilateral disease on CXR and over 27% with bilateral disease died of respiratory cause over the follow–up period.
Conclusions Not withstanding the limitations of this study, the likelihood of radiological progression with a diagnosis of DPT is 2 in 5, including those with unilateral disease. The risk of death from a respiratory cause with bilateral DPT diagnosed on CXR (27%) is more than twice that for unilateral disease on CXR (11%).
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