Commentary on pathologic diagnosis of asbestosis and critique of the 2010 Asbestosis Committee of the College of American Pathologists (CAP) and Pulmonary Pathology Society's (PPS) update on the diagnostic criteria for pathologic asbestosis

Our plain-English summary of Commentary on pathologic diagnosis of asbestosis and critique of the 2010 Asbestosis Committee of the College of American Pathologists (CAP) and Pulmonary Pathology Society's (PPS) update on the diagnostic criteria for pathologic asbestosis, by S.P. Hammar, J.L. Abraham (American Journal of Industrial Medicine, 2015).

The study

• Authors: S.P. Hammar, J.L. Abraham
• Journal: American Journal of Industrial Medicine
• Published: 2015;58(10):1034-9
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We reviewed the 2010 Asbestosis Committee's update on the diagnostic criteria for pathologic asbestosis. We must respectfully disagree with many of the criteria set forth therein, especially for recognizing asbestosis at its earliest stages; with statements focusing on the number of asbestos bodies needed in order to make a pathologic diagnosis of asbestosis; and regarding the benefits and pitfalls of relying on fiber analysis for diagnostic purposes, especially where chrysotile asbestos is concerned, including the methodology used for fiber determination. This critique has become even more relevant with the 2014 Helsinki criteria publication, which adopted the 2010 CAP/PPS criteria. Based on our review of these newer criteria and our experience in this field, we find that the CAP-NIOSH 1982 criteria is still the most acceptable method for the pathologic diagnosis and grading of asbestosis, which can be described as pulmonary fibrosis caused by inhalation of asbestos fibers.

© 2015 Wiley Periodicals, Inc.

In plain English

This article is a commentary, not a new study. The authors critiqued the 2010 update of the criteria for diagnosing asbestosis from lung tissue, issued by a committee of the College of American Pathologists and the Pulmonary Pathology Society and adopted by the 2014 Helsinki criteria. They argued that the 2010 "grade 0" lumps lungs with no fibrosis together with scarring of the small airway walls that the 1982 criteria called grade 1 asbestosis. They held that this scarring is early asbestosis. They wrote that they could find no logical reason for the change except to affect people's ability to seek compensation. They argued that the 2010 threshold of 2 asbestos bodies per square centimetre is at least 200 times a background level relied on by Roggli, the report's lead author. They also said the criteria give no guidance on how many sections to examine. Citing a 1986 study by Warnock and Isenberg, they noted that none of seven people with fibrosis in that study met that threshold. They criticized the missing conflict-of-interest declarations and the lack of NIOSH endorsement. The authors concluded that the 1982 CAP-NIOSH criteria remain the most acceptable method.

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: Commentary and critique of published diagnostic criteria; no new data collected
• Who was studied: No study population. The subject is the 2010 CAP/PPS diagnostic criteria for pathologic asbestosis (Roggli et al., 2010) and their adoption by the 2014 Helsinki criteria.
• Exposure: Asbestos fibers in general as the cause of asbestosis. The authors single out pure chrysotile exposure as a case where requiring asbestos bodies may give false negatives.
• Main results:
  • The authors argued that the 2010 grade 0 combines lungs with no fibrosis and fibrosis that the 1982 system classed as grade 1 asbestosis.
  • The authors argued that asbestos-caused fibrosis of the respiratory bronchiole wall (which the 2010 committee calls asbestos airways disease) is the early stage of asbestosis.
  • The authors stated they could find no logical reason for not calling bronchiolar wall fibrosis asbestosis, other than affecting a person's ability to seek compensation.
  • The authors calculated that the 2010 threshold of 2 asbestos bodies per square centimetre of tissue section corresponds to about 4,000 asbestos bodies per gram of wet lung. By their calculation, this is at least 200 times the upper background limit of 20 per gram relied on by Roggli.
  • From a 1986 study by Warnock and Isenberg (not this article's data), the authors noted that none of seven individuals with fibrosis and markedly elevated asbestos body and fiber counts had 2 or more asbestos bodies per square centimetre. Three of these seven met the 1982 criteria.
  • Citing earlier laboratory work, including their own, the authors stated that each asbestos body usually corresponds to 100 to 1,000 uncoated asbestos fibers in the lung.
  • The authors reported from their own experience cases with no asbestos bodies seen in tissue sections. In several of these, fiber analysis found fiber concentrations they considered great enough to cause asbestosis.
  • The authors noted that the 2010 criteria give no guidance on how many sections must be examined, or on whether iron stains are required.
  • The authors noted that the 2010 report lacked conflict-of-interest declarations and, unlike the 1982 criteria, NIOSH endorsement.
• The authors' conclusion: The authors concluded that the 1982 CAP-NIOSH criteria are still the most acceptable method for the pathologic diagnosis and grading of asbestosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Pathology, Asbestos Bodies, Chrysotile, Helsinki Criteria, NIOSH, Pulmonary Fibrosis.

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