Author reply: 'Response to: Pleural abnormalities in the Framingham Heart Study: prevalence and CT image features' by Araki et al

Our plain-English summary of Author reply: 'Response to: Pleural abnormalities in the Framingham Heart Study: prevalence and CT image features' by Araki et al, by T. Araki, G.M. Hunninghake, D.C. Christiani, et al (Occupational and Environmental Medicine, 2018).

The study

• Authors: T. Araki, G.M. Hunninghake, D.C. Christiani, H. Hatabu
• Journal: Occupational and Environmental Medicine
• Published: 2018;75(1):77-78
• Type of article: Letter, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a letter, not a new study. The authors of an earlier article on pleural abnormalities (including pleural plaques and pleural thickening) seen on CT scans in the Framingham Heart Study replied to comments by Franzblau and colleagues. The authors restated that their earlier study found pleural abnormalities in 1.5% of the cohort, which they suggested could be an index of asbestos exposure in the general population. They wrote that every case was confirmed by at least two readers and that equivocal findings were not counted in that figure. They agreed that comparing their CT results with chest X-ray results from the NHANES II survey has limitations. They gave three reasons: differences in technique, differences in age, gender and ethnicity, and possible differences in exposure history. They also agreed that the gap between the two might not reflect a true decline in prevalence. They stated that chest X-rays are generally thought to miss pleural plaques, especially non-calcified ones, and that false-positive CT diagnoses are thought to be very rare. They added that this remains unclear until X-rays and CT are compared directly in the same people. The authors concluded that CT characterises pleural abnormalities better than X-ray.

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: Letter (authors' reply to published correspondence about their earlier study); no new data
• Who was studied: No new population studied; the letter discusses the authors' earlier CT study of participants in the Framingham Heart Study cohort
• Exposure: Not studied directly. The authors describe pleural abnormalities as a possible index of asbestos exposure in the general population. No fiber types are named.
• Main results:
  • The authors restated that their earlier study found a prevalence of pleural abnormalities of 1.5% in the Framingham cohort
  • In the earlier study, all cases were confirmed by at least two readers. Equivocal findings were classed as minor pleural changes and were not included in the prevalence figure.
  • The authors agreed that the difference in prevalence from NHANES II might be driven by factors other than a true decline
  • The authors stated that chest X-rays are generally thought to underdiagnose pleural plaques, especially non-calcified ones
  • The authors stated that false-positive CT diagnoses of pleural plaques are thought to be very rare
  • The authors said their result suggests that involvement of the front (anterior) part of the pleura is common, which earlier X-ray-based literature had not described
• The authors' conclusion: The authors concluded that CT is better than X-ray at characterising pleural abnormalities. They said they hoped their study would help improve radiological diagnosis of asbestos-related pleural disease.
• Limitations the authors state:
  • The authors agreed that directly comparing their CT results with NHANES II chest X-ray results has limitations. The reasons were differences in technique, in demographic background, and in possible exposure history.
  • The authors said that whether X-ray or CT is more accurate remains unclear until both are compared in the same people

Related studies

• Pleural abnormalities in the Framingham Heart Study: prevalence and CT image features — T. Araki, M. Yanagawa, et al. (2017)
• Authors' response: A systematic review of the association between pleural plaques and changes in lung function — L. Kopylev, K.Y. Christensen, et al. (2015)
• 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)
• Pulmonary abnormalities as a result of exposure to Libby amphibole during childhood and adolescence-The Pre-Adult Latency Study (PALS) — J. Szeinuk, C.W. Noonan, et al. (2017)
• Libby Amphibole Disease: Pulmonary Function and CT Abnormalities in Vermiculite Miners — A. Miller, J. Szeinuk, et al. (2018)
• Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases — M. Metintas, I. Ucgun, et al. (2002)

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