An approach to industrial post mortems

Our plain-English summary of An approach to industrial post mortems, by R.L. Attanoos, A.R. Gibbs (Histopathology, 2009).

The study

• Authors: R.L. Attanoos, A.R. Gibbs
• Journal: Histopathology
• Published: 2009;54(1):134-42
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Industrial-related deaths represent a specialized aspect of autopsy practice. The purpose of this review is to assist the pathologist in the handling of such deaths. The diseases associated with the three most significant mineral dusts (asbestos, coal and silica) are described, together with a selection of less well-known mineral dust diseases. This review addresses the complex issues of ascribing disease to industrial exposures and the role of mineral analysis. The authors discuss the common medical legal issues that are encountered at post mortem and at inquest deposition.

In plain English

This article was a review, not a study of patients, and it reported no new data. The authors, from a histopathology department in Penarth, Wales, aimed to help pathologists carry out post mortems on deaths that may be related to industrial work. It covered diseases linked to asbestos, coal and silica, plus some less common mineral dusts and metals. The authors advised inflating at least one lung with formalin before cutting it. In deaths not related to a tumour, they advised taking a minimum of four and optimally 15 tissue blocks. They preferred transmission electron microscopy for fibre analysis. They wrote that a high fibre burden indicates exposure but is not proof of disease. They also wrote that a negative result is not proof that there was no significant exposure. They described pleural plaques as merely markers of asbestos exposure. They stated that asbestosis and asbestos-related lung cancer are associated with amphibole fibre counts above 20 million fibres per gram of dry lung. They gave a guideline under which pleural plaques alone do not support attributing a lung cancer to asbestos. The authors concluded that careful, systematic tissue sampling is needed to assess these cases accurately.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review giving practical guidance for pathologists; no original study data
• Who was studied: No study population. The review concerned post mortems on potential industrial-related deaths. The authors worked in the Department of Histopathology, University Hospital Llandough, Penarth, Wales, UK.
• Exposure: Mainly asbestos, coal and silica, plus less well-known mineral dusts and metals (silicates such as kaolin, mica, talc and fuller's earth; beryllium; hard metal). Asbestos types named are the amphiboles crocidolite, amosite, anthophyllite, tremolite and actinolite, and the serpentine chrysotile.
• Main results:
  • The authors advised that at least one lung be inflated with formalin before cutting, because assessment of collapsed lung is poor and inaccurate.
  • In non-tumour-related deaths, the authors advised taking a minimum of four and optimally 15 tissue blocks from set areas of the lungs.
  • The authors wrote that a high fibre burden indicates exposure but is not proof of disease.
  • The authors wrote that a negative result is not proof that significant exposure was absent, especially for white (chrysotile) asbestos.
  • The authors stated that asbestosis and asbestos-related lung cancer are associated with amphibole asbestos fibre counts above 20 million fibres per gram of dry lung. They also stated that counts of 1 million fibres or greater would be regarded as significant for their laboratory.
  • The authors named transmission electron microscopy as the preferred method of fibre analysis and advised sending cases to regional centres with proven expertise.
  • The authors described pleural plaques as merely markers of asbestos exposure that can occur with relatively trivial exposures and are not clinically significant.
  • The authors gave minimal criteria for a microscopic diagnosis of asbestosis: multifocal peribronchiolar fibrosis (more than 50% of respiratory bronchioles involved) plus two or more asbestos bodies per square centimetre of lung tissue. They stated that grade 1 asbestosis cannot be robustly diagnosed.
  • The authors disputed a statement by the Industrial Injuries Advisory Council that fibre counts are unreliable and miss clear-cut cases of asbestosis. They called that statement inaccurate and without scientific evidence.
  • For mesothelioma, the authors wrote that when the exposure history is weak and the fibre count is within the background range, it is doubtful the tumour was related to asbestos.
  • In the authors' guideline for lung cancer: asbestosis present means attribution to asbestos (Yes); pleural plaques only means No; a fibre count in the asbestosis range without fibrosis is Controversial; a fibre count within background levels means No; a raised count below the asbestosis range is Doubtful.
• The authors' conclusion: The authors concluded that minimalist histological sampling defeats the objectives of the post mortem. They held that a careful, systematic approach with appropriate sampling is necessary for an accurate assessment of these cases.

Topics

Medical terms in this study, explained in our Lexicon: Autopsy, Deposition.

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