Asbestos bodies in bronchoalveolar lavage in relation to asbestos bodies and asbestos fibres in lung parenchyma

Our plain-English summary of Asbestos bodies in bronchoalveolar lavage in relation to asbestos bodies and asbestos fibres in lung parenchyma, by A. Karjalainen, R. Piipari, T. Mäntylä, et al (The European Respiratory Journal, 1996).

The study

• Authors: A. Karjalainen, R. Piipari, T. Mäntylä, M. Mönkkönen, M. Nurminen, P. Tukiainen, E. Vanhala, S. Anttila
• Journal: The European Respiratory Journal
• Published: 1996;9(5):1000-5
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In Finland, unlike other countries, anthophyllite asbestos has been widely used due to its domestic production in 1918-1975. In this particular context, the aim of the present study was to analyse the relationship between asbestos bodies (ABs) in bronchoalveolar lavage (BAL) fluid and the concentration of ABs and the different amphibole asbestos fibres in lung tissue. Sixty five BAL lung tissue sample pairs from patients with pulmonary disease were analysed. The concentration of ABs in BAL fluid and lung tissue was determined with optical microscopy, and the concentration, type and dimensions of asbestos fibres in lung tissue with scanning electron microscopy. There was a significant correlation between the concentrations of ABs in BAL fluid and in lung tissue (r = 0.72; p < 0.001), between the concentrations of ABs and amphibole asbestos fibres in lung tissue (r = 0.73; p < 0.001), and between the concentration of ABs in BAL fluid and the concentration of amphibole asbestos fibres in lung tissue (r = 0.64; p < 0.001). In patients who had been exposed mainly to commercial anthophyllite, significantly higher concentrations of ABs were observed per total pulmonary amphibole fibre burden, as compared to patients whose main exposure was to crocidolite/amosite. The anthophyllite fibres in lung tissue were longer than the crocidolite/amosite fibres. The relationship between asbestos body counts in lung tissue and in bronchoalveolar lavage fluid was similar to previous international observations. When using the asbestos body count to predict the underlying total pulmonary amphibole asbestos burden in Finnish patients, however, it should be borne in mind that the relationship between the two parameters seems to be different with anthophyllite as compared to crocidolite/amosite fibres.

In plain English

This Finnish study compared asbestos body counts in lung-washing fluid (bronchoalveolar lavage, BAL) with asbestos bodies and asbestos fibres in lung tissue from the same 65 patients, whose samples were analysed in 1992–1994; 59 had lung cancer. Asbestos bodies were counted by optical microscopy and amphibole fibres by scanning electron microscopy, which detects chrysotile poorly. BAL counts correlated with lung tissue counts (r=0.72). Tissue counts correlated with tissue amphibole fibre concentrations (r=0.73), and BAL counts did too (r=0.64). All of these were statistically significant. In 8 samples dominated by anthophyllite, asbestos bodies averaged 0.44% of the amphibole fibre count, against 0.096% in 9 samples dominated by crocidolite/amosite, a statistically significant difference. Anthophyllite fibres were longer (median 7.5 versus 3.2 µm). The authors cautioned that this matters when estimating exposure from body counts in Finland. They noted that low or negative BAL counts did not rule out heavy exposure. They concluded that a personal work history is often the best way to judge past exposure, but that BAL counting offers a reasonably reliable estimate when work history is inconclusive or lacking.

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: Cross-sectional laboratory comparison of paired BAL fluid and lung tissue samples from the same patients
• Who was studied: 65 patients in Helsinki, Finland, whose samples were analysed in 1992–1994. Mean age was 65 (range 44–85). 59 had lung cancer, 1 mesothelioma, 1 lymphoma, 1 pneumonia and 3 benign pleural disease. Lung tissue came from surgery (26) or necropsy (39); most necropsies were done because an asbestos-related death was suspected.
• Exposure: Occupational asbestos exposure, classified from personal interviews. 45 (69%) were heavily or moderately exposed, 15 possibly exposed and 5 unlikely exposed. Fibres measured in lung tissue were amphiboles: anthophyllite and crocidolite/amosite. Crocidolite and amosite could not be told apart and were reported together.
• Main results:
  • Asbestos bodies were detected in 86% of BAL samples and 98% of lung tissue samples.
  • In all 65 patients, asbestos body concentrations in BAL fluid correlated with those in lung tissue (r=0.72; p less than 0.001).
  • In all 65 patients, asbestos bodies in lung tissue correlated with amphibole fibre concentration in lung tissue (r=0.73).
  • In all 65 patients, asbestos bodies in BAL fluid correlated with amphibole fibre concentration in lung tissue (r=0.64).
  • In samples mainly containing anthophyllite (8 cases), asbestos bodies divided by amphibole fibres was significantly higher than in samples mainly containing crocidolite/amosite (9 cases) (p=0.0043; t-test).
  • Asbestos bodies averaged 0.44% of the amphibole fibre concentration (range 0.07–0.89, SD=0.29) in anthophyllite-dominated samples. In crocidolite/amosite-dominated samples the figure was 0.096% (range 0.007–0.38, SD=0.12).
  • The ratio was about five times higher with mainly anthophyllite exposure. The authors said this should be borne in mind when asbestos body counts are used to estimate cumulative exposure in Finland.
  • Anthophyllite fibres in lung tissue were longer than crocidolite/amosite fibres (median 7.5 µm vs 3.2 µm). Fibres longer than 10 µm made up 45% of anthophyllite and 7.5% of crocidolite/amosite fibres (100 of each measured, from 12 samples).
  • Among cases with less than 1.0 asbestos body per mL in BAL, 92% had less than 10,000 bodies per gram and 96% less than 10 million amphibole fibres per gram of dry lung tissue. Among cases with 10 or more per mL in BAL, all had at least 1,000 bodies per gram and 90% at least 1.0 million amphibole fibres per gram.
  • A low or negative BAL count did not rule out heavy exposure. For example, a shipyard worker with mesothelioma had 100 million crocidolite/amosite fibres per gram but 730 asbestos bodies per gram and 6 per mL in BAL.
• The authors' conclusion: The authors concluded that a complete work history based on personal interview is often the best way to evaluate past asbestos exposure. Where the work history is inconclusive or lacking, they concluded that BAL asbestos body counting gives a reasonably reliable estimate of past exposure.
• Limitations the authors state:
  • Chrysotile is poorly detected by scanning electron microscopy, so the fibre results represent amphibole fibres only.
  • Amosite and crocidolite could not be distinguished and are reported together.
  • The anthophyllite findings apply only to Finnish patients exposed to commercially exploited and industrially processed anthophyllite.
  • Electron microscopy fibre counts vary widely between laboratories.
  • This study and earlier ones had few cases at very high asbestos body concentrations, so results are less consistent at those levels.
  • Some BAL samples may have been poorly representative of the lung.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Bodies, Bronchoalveolar Lavage (BAL), Parenchyma, Anthophyllite, Amphibole Asbestos, BAL Fluid, Scanning Electron Microscopy (SEM), Amphibole Group.

Related studies

• Fibres and asbestos bodies in bronchoalveolar lavage fluids of asbestos sprayers — T. Tuomi, P. Oksa, et al. (1992)
• Asbestos bodies in bronchoalveolar lavage fluid in relation to occupational history — A. Karjalainen, S. Anttila, et al. (1994)
• Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey — P. Dumortier, L. Coplü, et al. (2001)
• Distribution of asbestos bodies in the human lung as determined by bronchoalveolar lavage — H. Teschler, N. Konietzko, et al. (1993)
• Asbestos bodies in bronchoalveolar lavage fluids of brake lining and asbestos cement workers — P. Dumortier, P. De Vuyst, et al. (1990)
• Analysis of ferruginous bodies in bronchoalveolar lavage from foundry workers — R.F. Dodson, M. O'Sullivan, et al. (1993)

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