Asbestos plaques in a typical Veteran's hospital population

Our plain-English summary of Asbestos plaques in a typical Veteran's hospital population, by J.A. Miller, J.V. Zurlo (American Journal of Industrial Medicine, 1996).

The study

• Authors: J.A. Miller, J.V. Zurlo
• Journal: American Journal of Industrial Medicine
• Published: 1996;30(6):726-9
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Previous authors have described several pleural abnormalities on chest radiology as being pathognomonic for asbestos exposure. We sought to determine the percentage of admissions and outpatients at a typical Veteran's Affairs hospital with these findings, and researched medical records to verify the frequency at which patients having positive radiographs were suspected either by clinical/occupational history or radiologically to have had prior significant exposure to asbestos. Radiographs of 1,212 consecutive patients were evaluated by a certified B reader, and the medical records as well as previous radiology reports of all positive patients were reviewed. Twenty-eight (2.3%t) of the radiographs had pleural abnormalities consistent with asbestos exposure, with the patients, all male, ranging in age from 50 to 98 years (mean 75.6). Radiology reports described pleural plaques in only 12 of the 21 (57%) cases with prior exams available; in only seven (33%) was an asbestos etiology considered by the interpreting radiologist. The plaques were misdiagnosed in four instances as being indicative of other, unrelated pathology. A history of known dust exposure was expressed by only five patients (18%). Eleven described working in occupations now known to have a high incidence of exposure, but neither patient nor examining physician expressed consideration of dust inhalation. In conclusion, we have found that a significant percentage of patients in certain subpopulations show radiographic evidence of asbestos exposure that may be a harbinger of related pathology. Unfortunately, because of a low index of suspicion, thorough environmental histories are often deferred, many radiographic changes are either not recognized or are misdiagnosed, and these patients are not followed with the stringent protocols they deserve.

In plain English

This study looked at how often chest X-rays at a Veterans Affairs hospital showed pleural changes consistent with asbestos exposure, and whether those changes had been noticed before. A NIOSH-certified B reader, one of the authors, prospectively read the chest X-rays of 1,212 consecutive outpatients and admissions at the East Orange Veteran's Affairs Medical Center from July through November 1995. Twenty-eight X-rays (2.3%) showed pleural abnormalities consistent with asbestos exposure. All 28 of these patients were men aged 50 to 98. Four of the 28 also had lung changes suggestive of asbestosis. Of the 21 with earlier radiology reports, the original radiologists had mentioned pleural abnormalities in 12 and had considered asbestos in seven. Some plaques had been read as other conditions, including nodules consistent with cancer spread to the lungs. Only 14 patients had any occupational history in their charts, and five reported known asbestos exposure. The authors concluded that asbestos-related pleural disease was unexpectedly common in certain populations and often went undetected. They noted that a single reader, rather than a panel, read all the films.

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: Prospective review of consecutive chest radiographs by a single B reader (a prevalence survey), followed by review of prior radiographs, prior radiology reports and medical records of patients with positive films
• Who was studied: 1,212 consecutive outpatients and admissions (1,164 male, 96%; 48 female, 4%; age range 23-98 years) at the East Orange Veteran's Affairs Medical Center, July through November 1995
• Exposure: Asbestos exposure was not measured directly. Pleural abnormalities on chest X-ray were used as an indicator of possible prior asbestos exposure. Medical records were checked for occupation and for any history of chemical or dust exposure. Occupations named include construction and shipbuilding. No fiber type is named.
• Main results:
  • 28 of the 1,212 radiographs (2.3%) showed pleural abnormalities considered consistent with asbestos exposure. All 28 patients were male, aged 50 to 98 years (mean 75.6).
  • Among the 28 patients with positive films, 20 (71%) had bilateral abnormalities, 20 (71%) had calcified abnormalities, and 3 (11%) had diffuse pleural disease.
  • On review of prior radiographs, no significant progression in the degree or distribution of pleural disease was detected.
  • 4 of the 28 (14%) had interstitial changes suggestive of asbestosis. None had parenchymal masses.
  • Previous radiology reports mentioned pleural abnormalities in 12 of the 21 cases with prior exams (57%). The original radiologist considered asbestos exposure in only seven of these cases (33%).
  • Some plaques had been misread by radiologists as other conditions: focal parenchymal fibrosis, a loculated pleural effusion, granulomata, and nodules consistent with pulmonary metastases.
  • Only 14 of the 28 patients had even a cursory occupational history in their charts. Five patients (18%) expressed a definite history of known asbestos exposure.
  • Eleven patients (39%) described occupations with a high incidence of exposure, such as construction or shipbuilding. In only four of them was the possibility of dust inhalation mentioned by the patient or the examining physician.
  • Among the 28 patients, 15 were smokers, 9 reported no tobacco use, and no cigarette history was obtained for 4.
• The authors' conclusion: The authors concluded that certain populations have an unexpectedly high incidence of radiographically evident asbestos-related pleural disease. They found that this disease often goes undetected when films are interpreted, and that few clinical histories are thorough enough to establish a precise occupational background.
• Limitations the authors state:
  • All radiographs were read by only one interpreter, rather than by a panel, which is often considered the standard.
  • The study did not attempt to determine the sensitivity, specificity, or positive predictive value of the detected pleural disease for asbestos exposure.

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, Occupational History, Pleural Plaques, Etiology, Pathology.

Related studies

• A principal factor analysis to characterize agricultural exposures among Nebraska veterans — L. Weissenburger-Moser, J. Meza, et al. (2017)
• Association of Agricultural, Occupational, and Military Inhalants With Autoantibodies and Disease Features in US Veterans With Rheumatoid Arthritis — A.V. Ebel, G. Lutt, et al. (2021)
• Living with mesothelioma: A qualitative study of the experiences of male military veterans in the UK — S. Ejegi-Memeh, L. Darlison, et al. (2021)
• Asbestos exposure and mesothelioma mortality among atomic veterans — J.E. Till, H.L. Beck, et al. (2022)
• The Veterans Administration's Asbestos Abatement Program — G.W. Schepers (1991)
• Pleural plaques: only an imagiologic finding? — P. Almeida, A. Araújo (2019)

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