Asbestos-related pleural disease

Our plain-English summary of Asbestos-related pleural disease, by R. Myers (Current Opinion in Pulmonary Medicine, 2012).

The study

• Author: R. Myers
• Journal: Current Opinion in Pulmonary Medicine
• Published: 2012;18(4):377-81
• Type of article: Review
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose Of Review: Asbestos exposure is the cause of significant pleural disease - both benign and malignant. Although there is increased awareness, individuals continue to be exposed, and we will continue to see its sequelae for years to come because of the delay between exposure and disease manifestation. Asbestos-related pleural disease includes pleural plaques, diffuse pleural thickening, benign asbestos-related pleural effusions (BAPEs), and malignant pleural mesothelioma (MPM).

Recent Findings: Several recent studies are highlighted throughout this review, including a comparative analysis of diagnostic imaging modalities for identifying and characterizing pleural plaques, the effect of pleural plaques on lung volumes and flows, and how pain is a relatively common feature in patients with pleural plaques. Advances in the treatment of MPM are limited, but a recent publication highlights the increased morbidity associated with surgical debulking procedures and questions the benefit of these procedures.

Summary: Asbestos-related pleural disease will continue to present a significant burden of illness. Recent publications have suggested potential treatment benefit and point to areas that would require further investigation.

In plain English

This article was a narrative review, not an original study. The author reviewed studies published over the preceding 18 months on asbestos-related pleural disease: pleural plaques, diffuse pleural thickening, benign asbestos-related pleural effusions and malignant pleural mesothelioma. Among the work described, one cited study of 140 asbestos-exposed construction workers reported that chest X-ray failed to detect pleural plaques only 3.7% of the time when compared with CT. Another cited study linked plaques to a statistically significant but minimal fall in lung function, of unknown clinical significance. A cited retrospective study of 167 patients reported pain in 50% of patients with diffuse pleural thickening and 47% of those with plaques. A cited prospective study of patients with epithelial mesothelioma found that pleurectomy/decortication had lower morbidity and mortality than extrapleural pneumonectomy, without a significant difference in overall survival. The author concluded that plaques, though benign, mark significant exposure, and that it is unclear whether surgery offers a survival advantage over palliative chemotherapy.

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 recent literature on asbestos-related pleural disease
• Who was studied: No study population of its own. The review covered published research on pleural plaques, diffuse pleural thickening, benign asbestos-related pleural effusions and malignant pleural mesothelioma.
• Exposure: Asbestos exposure in general. No specific fiber type or dose was analysed.
• Main results:
  • Reported from a cited study of 140 asbestos-exposed construction workers, with CT as the gold standard: chest X-ray failed to detect pleural plaques 3.7% of the time, when the plaques were in the paravertebral area.
  • Reported from a cited study: isolated parietal and/or diaphragmatic plaques were associated with a statistically significant decrease in lung volumes and flows compared with controls. The decrease was minimal and its clinical significance unknown.
  • Reported from a cited retrospective study of 167 patients with pleural-related asbestos disease: pain was reported in 50% of patients with diffuse pleural thickening and 47% of patients with pleural plaques.
  • Reported from a cited prospective study of 174 patients with epithelial malignant pleural mesothelioma: of 77 with early-stage disease, 40 had extrapleural pneumonectomy and 37 had pleurectomy/decortication. The pleurectomy/decortication group had lower morbidity and mortality and better quality-of-life scores until recurrence. Overall survival did not significantly differ between the two procedures.
  • Reported from several cited retrospective studies: 5-year survival rates for malignant pleural mesothelioma as low as 1% or less.
  • Reported from a cited study: serum mesothelin had greater than 90% specificity but only 50% sensitivity for mesothelioma.
• The authors' conclusion: The author concluded that pleural plaques are benign but mark significant asbestos exposure, which is a risk for lung cancer, and that a screening protocol is necessary. The author also concluded that it is unclear whether surgery offers a survival advantage over palliative cisplatin-antifolate chemotherapy, that further studies comparing the two are required, and that a lung-sparing procedure appears superior to extrapleural pneumonectomy when surgery is chosen.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos-Related Pleural Disease, Asbestos Exposure, Pleural Plaques, Diffuse Pleural Thickening, Pleural Effusion, Pleural Mesothelioma.

Related studies

• Benign asbestos-related pleural disease — C. King, D. Mayes, et al. (2011)
• Asbestos-related diffuse pleural thickening — N. Fujimoto, K. Kato, et al. (2014)
• Biological responses to asbestos inhalation and pathogenesis of asbestos-related benign and malignant disease — E. Solbes, R.W. Harper (2018)
• Ultra low dose CT screen-detected non-malignant incidental findings in the Western Australian Asbestos Review Programme — C.P. Murray, P.M. Wong, et al. (2016)
• Diagnosis and initial management of nonmalignant diseases related to asbestos — American Thoracic Society (2004)
• Asbestos-related pleural disease and asbestosis: a comparison of CT and chest radiography — A.C. Friedman, S.B. Fiel, et al. (1988)

Browse more research in Current Opinion in Pulmonary Medicine, or return to medical research.