Asbestos-related chest diseases: plain radiographic findings

Our plain-English summary of Asbestos-related chest diseases: plain radiographic findings, by W.T. Miller, W.B. Gefter, W.T. Miller (Seminars in Roentgenology, 1992).

The study

• Authors: W.T. Miller, W.B. Gefter, W.T. Miller
• Journal: Seminars in Roentgenology
• Published: 1992;27(2):102-20
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In summary, there are a wide range of pulmonary manifestations seen in asbestos-exposed individuals from pleural and parenchymal fibrosis to pleural and parenchymal malignancy. The chest roentgenogram has assumed an important role in the detection and surveillance of asbestos-related pleural and parenchymal changes.

In plain English

This article was a narrative review of what plain chest X-rays show in people exposed to asbestos. It summarized published work rather than reporting a new study of its own. The authors covered pleural plaques, benign asbestos pleural effusion, diffuse pleural thickening, asbestosis, rounded atelectasis, lung cancer and mesothelioma, citing other studies throughout. They stated that focal bilateral plaque-like pleural thickening is an almost certain indicator of prior asbestos exposure. In one cited autopsy comparison, liberal X-ray reading criteria detected 46% of autopsy-proven cases of pleural plaques, but with a false-positive rate of 58%. Calcification was reported at autopsy in up to 87% of cases with pleural plaques, while on plain films it was seen in only about 15% of patients. One cited study found interobserver variation of 18% in classifying small irregular opacities. The authors cited data that smoking and asbestos exposure increase lung cancer risk in a multiplicative fashion, and recent data suggesting that mesothelioma is not a manifestation of chrysotile exposure. The authors concluded that the chest X-ray, though imperfect, is probably the best tool currently available for assessing asbestosis.

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 on plain chest radiograph findings in asbestos-related chest disease, illustrated with example films
• Who was studied: No study population of its own; the review drew on published studies of asbestos-exposed groups and on illustrative chest radiographs
• Exposure: Asbestos exposure in general, both occupational and nonoccupational; no single fiber type, product or dose was studied
• Main results:
  • The authors stated that focal bilateral plaque-like pleural thickening is an almost certain indicator of prior asbestos exposure
  • Cited autopsy study (Hillerdal and Lindgren): with liberalized radiographic criteria, 46% of autopsy-proven cases of pleural plaques were detected, with a false-positive rate of 58%
  • Cited studies: calcification was reported in autopsy studies in as many as 87% of the cases of pleural plaques
  • Cited studies: calcification of pleural plaques was seen on plain films in only about 15% of patients
  • Benign asbestos pleural effusion was described as having the shortest latency period of the asbestos-related diseases
  • Cited study of the ILO classification of small irregular opacities: intraobserver variation of 3.9% and interobserver variation of 18%
  • Cited data from Selikoff: cigarette smoking and asbestos exposure increase lung cancer risk in a multiplicative fashion
  • Cited data from Selikoff: taking the risk for a nonexposed nonsmoker as 1, the relative risk for asbestos-exposed workers was approximately 5
  • Cited recent data suggested that mesothelioma is caused only by amphibole fibers and is not a manifestation of chrysotile asbestos exposure; the review presented this as a suggestion from the data
  • Cited reports: other radiographic evidence of asbestos exposure (pleural plaques and/or interstitial fibrosis) was found in only 20% of mesothelioma cases
  • Mesothelioma was described as having an average survival of 6 months from diagnosis, with few survivors beyond 2 years
• The authors' conclusion: The authors concluded that, although imperfect, the chest radiograph is probably the best and most useful tool currently available for assessing asbestosis
• Limitations the authors state:
  • The authors noted that no studies were available comparing autopsy findings with pleural plaques detected by CT or high-resolution CT

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Parenchymal Fibrosis.

Related studies

• Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease — S. Mukherjee, N. de Klerk, et al. (2000)
• Surgical treatment of asbestos-related disease of the chest — L.P. Faber (1988)
• Trends in pleural radiographic findings in the Navy Asbestos Medical Surveillance Program (1990-1999) — J.G. Muller, B.K. Bohnker, et al. (2005)
• Increased body mass index is related to apparent circumscribed pleural thickening on plain chest radiographs — Y.C. Lee, C.K. Runnion, et al. (2001)
• Risk and significance of chest radiograph and pulmonary function abnormalities in an elderly cohort of former nuclear weapons workers — M.A. Mikulski, P.G. Hartley, et al. (2011)
• Associations between radiographic findings and spirometry in a community exposed to Libby amphibole — T.C. Larson, M. Lewin, et al. (2012)

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