Asbestos content of lung tissue in asbestos associated diseases: a study of 110 cases

Our plain-English summary of Asbestos content of lung tissue in asbestos associated diseases: a study of 110 cases, by V.L. Roggli, P.C. Pratt, A.R. Brody (British Journal of Industrial Medicine, 1986).

The study

• Authors: V.L. Roggli, P.C. Pratt, A.R. Brody
• Journal: British Journal of Industrial Medicine
• Published: 1986;43(1):18-28
• Cited by: 119 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001167).

Abstract

Diseases associated with asbestos exposure include asbestosis, malignant mesothelioma, carcinoma of the lung, and parietal pleural plaques. In this study the asbestos content of lung tissue was examined in groups of cases representing each of these diseases and in several cases with non-occupational idiopathic pulmonary fibrosis. Asbestos bodies (AB), which are the hallmark of asbestos exposure, were present in the lungs of virtually everyone in the general population and present at increased levels in individuals with asbestos associated diseases. The highest numbers of AB occurred in individuals with asbestosis, all of whom had levels greater than or equal to 2000 ABs/g wet lung tissue. Every case with a content of 100,000 ABs/g or higher had asbestosis. Intermediate levels occurred in individuals with malignant mesothelioma and the lowest levels in patients with parietal pleural plaques. There was no overlap between the asbestos content of lung tissue from patients with asbestosis and those with idiopathic pulmonary fibrosis. Lung cancer was present in half the patients with asbestosis, and the distribution of histological patterns did not differ from that in patients with lung cancer without asbestosis. The asbestos body content in patients with lung cancer was highly variable. Control cases had values within our previously established normal range (0-20 ABs/g). There was a significant correlation (p less than 0.001) between AB counted by light microscope and AB and uncoated fibres counted by scanning electron microscopy. The previous observation that the vast majority of asbestos bodies isolated from human tissues have an amphibole core was confirmed.

In plain English

This study measured lung-tissue asbestos in 110 patients. They were seen at Duke University or Durham Veterans Administration medical centers, or referred to one author, from July 1980 to April 1984. The groups were asbestosis, mesothelioma, parietal pleural plaques without asbestosis, and lung cancer without plaques or asbestosis. Controls were 10 patients with idiopathic pulmonary fibrosis (median 9 asbestos bodies per gram, range 0.8 to 148) and 10 with normal lungs (median 3, range 0.2 to 22), against the authors' normal range of 0 to 20. All 30 asbestosis patients had at least 2000 asbestos bodies per gram of wet lung, and every patient with 100 000 or more had asbestosis. Their counts did not overlap with idiopathic pulmonary fibrosis cases. Fifteen asbestosis patients also had lung cancer. Among 15 mesothelioma patients without asbestosis, 10 had counts above the normal range. Above-normal counts were more frequent with bilateral than unilateral plaques (79% versus 50%), a difference that was not significant. Of asbestos body cores analysed, 93.9% were amosite or crocidolite. The authors concluded that asbestos body content is a reasonably reliable marker for long amphibole fibres but says little about chrysotile.

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: Pathology case series measuring asbestos bodies and uncoated fibres in lung tissue (light microscopy and scanning electron microscopy with fibre analysis), with control cases
• Who was studied: 110 patients: 30 with asbestosis, 19 with mesothelioma (4 of whom also had asbestosis), 48 with parietal pleural plaques without asbestosis, and 17 with lung cancer without plaques or asbestosis. 57 were seen at Duke University Medical Center or Durham Veterans Administration Medical Center and 53 were referred to one author, July 1980 to April 1984. Controls were 10 cases of idiopathic pulmonary fibrosis and 10 with normal lungs.
• Exposure: Asbestos content of lung tissue (asbestos bodies and uncoated fibres, with fibre type identified as commercial amphiboles amosite or crocidolite, non-commercial amphiboles, or chrysotile), compared with occupational and smoking history taken from medical records
• Main results:
  • In the 10 control cases with normal lungs, the authors wrote that asbestos body values compared well with their previously established normal range of 0 to 20 asbestos bodies per gram. Table 2 gives a median of 3 and a range of 0.2 to 22 asbestos bodies per gram for this group.
  • In the 10 idiopathic pulmonary fibrosis controls, Table 2 gives a median of 9 asbestos bodies per gram (light microscopy), with a range of 0.8 to 148.
  • All 30 patients with asbestosis had at least 2000 asbestos bodies per gram of wet lung, with a median above 100 000 per gram.
  • Every patient with 100 000 or more asbestos bodies per gram (light microscopy) had asbestosis confirmed histologically.
  • Asbestos body and uncoated fibre concentrations in asbestosis did not overlap with those in idiopathic pulmonary fibrosis cases.
  • Of the 30 patients with asbestosis, 15 had carcinoma of the lung.
  • Among the 15 mesothelioma patients without asbestosis, asbestos body counts were above the normal range in 10, nine of whom had definite occupational asbestos exposure.
  • Among pleural plaque patients, counts above the normal range were found in 26 of 33 (79%) with bilateral plaques and 6 of 12 (50%) with unilateral plaques. The difference was not significant.
  • Among the 17 lung cancer patients without plaques or asbestosis, asbestos body counts were increased in 12 (71%).
  • Among asbestosis patients, asbestos body content did not differ significantly between those with and without lung cancer (p = 0.74; medians 118 000 and 90 000 asbestos bodies per gram).
  • There was no apparent trend in lung cancer histological types between patients with asbestosis, without asbestosis but with increased asbestos bodies, and with normal asbestos body counts.
  • In asbestosis cases with three or more histological sections, grade of asbestosis correlated with total fibre count by SEM (r = 0.57) and uncoated fibre count by SEM (r = 0.56).
  • Grade of asbestosis also correlated with smoking history in pack-years (n = 15, r = 0.53, p less than 0.05).
  • The 62 workers with direct asbestos exposure had a median of 10400 asbestos bodies per gram.
  • Asbestos body counts by light microscopy and by scanning electron microscopy correlated closely over a wide range of values.
  • Of asbestos body cores analysed, 93.9% were commercial amphiboles (amosite or crocidolite).
• The authors' conclusion: The authors concluded that asbestos body content is a reasonably reliable marker for levels of long amphibole fibres in the lung.
• Limitations the authors state:
  • Because of biases in how cases were referred, the study cannot be used to calculate the incidence of lung cancer in patients with asbestosis.
  • Short fibres (under 5 micrometres) were not evaluated, so the authors cannot comment on their possible link with these diseases.
  • Asbestos bodies give little or no indication of chrysotile content in the lung.
  • Where amphibole fibre content was high (100 000 or more per gram of wet lung), chrysotile fibres were difficult to identify by SEM.
  • In the centrifugation digestion method, a variable and sometimes substantial share of small chrysotile fibres was lost.
  • The authors described the correlation between asbestosis grade and fibre counts as less than impressive.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer, Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Malignant Mesothelioma, Carcinoma, Pleural Plaques, Idiopathic, Pulmonary Fibrosis, Asbestos Bodies, Lung Cancer.

Related studies

• Asbestos content of lung tissue, lymph nodes, and pleural plaques from former shipyard workers — R.F. Dodson, M.G. Williams, et al. (1990)
• An examination of the fibrous mineral content of asbestos lung tissue from the Canadian chrysotile mining industry — F.D. Pooley (1976)
• Formation of the nitrative DNA lesion 8-nitroguanine is associated with asbestos contents in human lung tissues: a pilot study — Y. Hiraku, K. Sakai, et al. (2014)
• Discrepancies of asbestos body and fiber content between formalin-fixed and corresponding paraffin embedded lung tissue — B.K. Kuhn, F. Barresi, et al. (2021)
• Pleuropulmonary fibrosis after long-term treatment with the dopamine agonist pergolide for Parkinson Disease — R. Tintner, P. Manian, et al. (2005)
• Correlation between the tissue response and asbestos fiber content — A.G. Heppleston (1974)

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