Asbestos exposure diagnosis in pulmonary tissues

Our plain-English summary of Asbestos exposure diagnosis in pulmonary tissues, by D. Bellis, A. Croce, A. Glorioso, et al (Pathologica, 2024).

The study

• Authors: D. Bellis, A. Croce, A. Glorioso, M. Bertolotti, A. Maconi
• Journal: Pathologica
• Published: 2024;116(4):207-215
• Type of article: Review
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The diagnosis of asbestosis requires different criteria depending on whether it is in a clinical or medical/legal setting. In the latter context, only when a "diffuse interstitial fibrosis associated to asbestos bodies (ABs)" is present, it can be said to be asbestosis. Considering the medical/legal setting, the diagnosis must be certain and proven. Unfortunately, it is often difficult to identify ABs by light microscopy (LM), but this does not mean that the diagnosis should be clinically excluded. Other parameters are important, such as working history and/or diagnostic imaging. In addition to LM, normally used for diagnosis, there are other techniques, e.g.: scanning electron microscopy with attached microanalysis microprobe (SEM/EDS), but they require tissue digestion and higher cost. A new approach with micro-Raman spectroscopy and SEM/EDS techniques is able to analyse histological sections without other manipulations that could interfere with analysis of asbestos fibres. In this work, we propose an algorithm for asbestosis diagnosis, especially in the forensic medical field, demonstrating the importance of close collaboration between multiple professionals.

Copyright © 2024 Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.

In plain English

This article was a review by researchers in Piedmont, Italy, on how to diagnose asbestosis (lung scarring linked to asbestos) from lung tissue, especially for medico-legal purposes. The authors searched PubMed for articles from the previous 10 years. They combined that literature with their own laboratory experience to propose a step-by-step working scheme. They stated that a histological diagnosis requires lung fibrosis plus typical asbestos bodies in tissue sections (more than 1 per cm2), and that clinical and radiological findings alone are not sufficient to answer medico-legal questions. Citing earlier studies, they reported that chest X-ray had a sensitivity of only 51%, while chest CT had a sensitivity of 70% and a specificity of 91%. They noted that chrysotile fibres rarely form asbestos bodies and are hard to identify in tissue sections. They described scanning electron microscopy with microanalysis (SEM/EDS) and micro-Raman spectroscopy as ways to characterise asbestos directly in routine histological sections. In their scheme, a negative result does not exclude work exposure. The authors concluded that cooperation among mineralogists, biologists, clinicians, radiologists and pathologists is necessary.

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 of the literature combined with the authors' laboratory experience, proposing a diagnostic protocol (algorithm)
• Who was studied: Published literature found in PubMed using the keywords "practice guidelines and asbestosis" and "asbestos in lung tissues" over the last 10 years. No patient group was studied.
• Exposure: Coated asbestos fibres (asbestos bodies) and uncoated asbestos fibres in lung tissue, including amphiboles and chrysotile, and the techniques used to detect them (light microscopy, SEM/EDS, micro-Raman spectroscopy)
• Main results:
  • For a histological diagnosis of asbestosis, the authors stated a requirement of bronchiolar/interstitial fibrosis plus typical asbestos bodies in histological sections (more than 1 per cm2). They called this at least the criterion required for recognition as an occupational disease.
  • Clinical and radiological diagnosis alone was described as not sufficient for medico-legal questions.
  • From the cited literature, standard chest X-ray had a sensitivity of only 51% for asbestosis.
  • From the cited literature, chest CT had a sensitivity of 70% and a specificity of 91% for asbestosis.
  • From the literature summarised in a table, 95% of patients with asbestosis had asbestos bodies in bronchoalveolar lavage fluid.
  • Chrysotile fibres were described as difficult to identify in histological sections because they rarely form asbestos bodies.
  • Micro-Raman spectroscopy and SEM/EDS were described as able to characterise asbestos directly inside routine histological sections.
  • In the authors' proposed working scheme, a "NO" result does not exclude work exposure. It means only that confirmation of asbestos presence could not be obtained.
• The authors' conclusion: The authors concluded that identifying asbestos in lung tissue for asbestosis diagnosis requires interaction among mineralogists, biologists, clinicians, radiologists and pathologists. They proposed their scheme as a possible path for both therapy and legal compensation.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Interstitial Fibrosis, Asbestos Bodies, Scanning Electron Microscopy (SEM), Tissue Digestion.

Related studies

• Study of inorganic particles, fibers, and asbestos bodies by variable pressure scanning electron microscopy with annexed energy dispersive spectroscopy and micro-Raman spectroscopy in thin sections of lung and pleural plaque — C. Rinaudo, A. Croce, et al. (2010)
• A method for extracting ferruginous bodies from sputum and pulmonary tissue — M.J. Smith, B. Naylor (1972)
• A novel method for accurate collagen and biochemical assessment of pulmonary tissue utilizing one animal — C.R. Kliment, J.M. Englert, et al. (2011)
• Chrysotile-induced asbestosis: changes in the free cell population, pulmonary surfactant and whole lung tissue of rats — T.D. Tetley, P.M. Hext, et al. (1976)
• Asbestos fibers in human pulmonary and extrapulmonary tissues — J. Huang, N. Hisanaga, et al. (1988)
• Asbestos in peripheral lung culture a species comparison of pulmonary tissue response — M.E. Placke, G.L. Fisher (1987)

Browse return to medical research.