Correlation between lung asbestos count at necropsy and radiological appearances

Our plain-English summary of Correlation between lung asbestos count at necropsy and radiological appearances, by P. Macpherson, J.K. Davidson (British Medical Journal, 1969).

The study

• Authors: P. Macpherson, J.K. Davidson
• Journal: British Medical Journal
• Published: 1969;1(5640):355-7
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001426).

Abstract

In the first 100 of a series of 600 consecutive necropsies for which a chest x-ray film had been taken within a year of death the features of asbestosis were observed in eight of the nine cases where the asbestos count at subsequent necropsy exceeded 40. In only one of these cases had the diagnosis of asbestosis been suggested during life. The higher the asbestos count the greater the likelihood of radiographic abnormalities, particularly calcified and non-calcified pleural plaques on the chest wall and diaphragm.

In plain English

This retrospective survey in Glasgow compared lung asbestos body counts made at necropsy (autopsy) with chest x-rays taken before death. It covered the first 100 cases, from a series of 600 consecutive necropsies, that had a chest x-ray taken within one year of death. Two radiologists, working independently and without knowing the counts, reviewed frontal x-rays for signs of asbestosis. The count was positive in 44 cases and negative in 56. Signs suggestive of asbestosis appeared in 9 of the 44 positive-count cases and in one negative-count case. Two of these ten turned out to be other diseases: tuberculosis and progressive systemic sclerosis. Signs were present in eight of the nine cases with counts above 40. At the original x-ray reporting, asbestosis had been suggested in only one of those eight. The commonest finding was a non-calcified pleural plaque on the lateral (side) chest wall. All 12 cases with counts over 10 were men, and 10 of them had a definite history of industrial asbestos exposure. The authors observed that the higher the count, the greater the likelihood of x-ray changes.

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: Retrospective survey comparing chest radiographs (read blind by two radiologists) with asbestos body counts made at necropsy
• Who was studied: The first 100 cases, from a series of 600 consecutive necropsies at the Western Infirmary, Glasgow (reported by Gibson et al., 1968), that had a chest radiograph taken within one year of death
• Exposure: Asbestos bodies counted in a single unstained 30-micron paraffin section of lung from the base of either lower lobe, over an area 15 cm square. Fiber types are not named. Occupational history was reported only for the 12 cases with counts over 10.
• Main results:
  • The asbestos count was positive in 44 of the 100 cases and negative in 56.
  • Radiological evidence suggestive of asbestosis was found in 9 of the 44 positive-count cases and in 1 negative-count case.
  • Two of these were false positives. The negative-count case was progressive systemic sclerosis. A woman with a count of 2 had tuberculosis.
  • X-ray changes of asbestosis were present in 8 of the 9 cases whose count exceeded 40. The remaining case showed no radiographic evidence of pulmonary disease.
  • At the original reporting, the possibility that the abnormalities were due to asbestosis had been recognised in only 1 of the 8 cases.
  • The commonest finding was the non-calcified pleural plaque on the lateral chest wall. Calcified diaphragmatic pleural plaques were the second most common.
  • Among the 35 positive-count cases with negative radiographs, the count exceeded 10 only four times (28, 33, 39 and 60).
  • All 12 cases with counts over 10 were male, and 10 had a definite history of industrial asbestos exposure. The other two, an electrician (count 95) and a painter and decorator (count 98), were found on inquiry to have possibly been exposed.
• The authors' conclusion: The authors stated that the higher the asbestos count, the greater the likelihood of positive radiographic features. They said their findings support the view that radiographic features of asbestosis are more common than had been appreciated.
• Limitations the authors state:
  • Lateral (side-view) radiographs, which often show abnormalities of the posterior diaphragm and posterior sulcus, were available only for some cases, so only frontal radiographs were used.

Topics

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

Medical terms in this study, explained in our Lexicon: Autopsy, Chest X-Ray, Pleural Plaques, Diaphragm.

Related studies

• Radiological and pathological correlations in asbestosis in the Republic of South Africa and the United Kingdom. II. A preliminary study of observer variation in the classification of radiographs of asbestos-exposed workers and the relation of pathology and x-ray appearances — A. Caplan, J.C. Gilson, et al. (1965)
• Radiological and pathological correlations in asbestosis in the Republic of South Africa and the United Kingdom. I. A proposed radiological classification of asbestosis — G.K. Sluis-Cremer, C.P. Theron (1965)
• Solitary malignant mesothelioma of the small intestine: radiological appearances — N. Gourtsoyiannis, D. Bays, et al. (1996)
• Pathologica, physiological, and radiological correlations in the pneumoconioses — E.A. Gaensler, C.B. Carrington, et al. (1972)
• Asbestos bodies in lungs at necropsy — G.H. Roberts (1967)
• Prevalence of "asbestos" bodies in human lungs at necropsy — T.E. Dicke, B. Naylor (1969)

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