Current issues in the pathologic and mineralogic diagnosis of asbestos-induced disease

Our plain-English summary of Current issues in the pathologic and mineralogic diagnosis of asbestos-induced disease, by A. Churg (Chest, 1983).

The study

• Author: A. Churg
• Journal: Chest
• Published: 1983;84(3):275-80
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001713).

In plain English

This article reviewed pathologic and mineral-analysis diagnosis of asbestos-related diseases. The author argued that asbestos bodies in tissue show exposure only, not disease. In the author's view, asbestosis was diagnosed pathologically by diffuse interstitial fibrosis and inflammation in the pattern of usual interstitial pneumonia, with asbestos bodies, but could be established without histologic examination given a good exposure history and compatible clinical findings. The author proposed calling small-airway lesions "asbestos airways disease" rather than asbestosis. The author knew of no pathologic method to attribute a smoker's lung cancer to asbestos. For mesothelioma, the author saw diagnosis, not cause, as the main problem. The author wrote that a million chrysotile fibers per gram of dry lung fit general-population background levels. A million amosite or crocidolite fibers per gram almost certainly indicated substantial occupational exposure. One woman had washed her husband's asbestos-laden work clothes and developed malignant mesothelioma 30 years later. In her lungs, the author's laboratory found a 30-fold increase in commercial amphiboles compared with nine control lungs. The author concluded that attributing asbestos-induced cancers has no easy scientific solution at present.

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 pathologic and mineralogic diagnosis, including one illustrative household-contact case analysed by the author's laboratory
• Who was studied: No study population. One illustrative case: a woman with malignant mesothelioma whose lungs were analysed and compared with a control group of 9
• Exposure: Asbestos in general: chrysotile and the amphiboles (amosite and crocidolite as commercial types; tremolite, anthophyllite and actinolite as contaminants). In the case, the exposure was household contact through washing work clothes
• Main results:
  • In the household-contact mesothelioma case, lung analysis showed a 30-fold increase in commercial amphiboles (amosite and crocidolite), which the author took as confirming an asbestos cause
  • Asbestos bodies per gram of dry lung: 280 in the control group (n = 9) versus 2500 in the mesothelioma case
  • Author's view: asbestos bodies alone are not disease and are not asbestosis
  • Author's view: the diagnostic pathologic features of asbestosis are diffuse interstitial fibrosis and inflammation in the pattern of UIP (usual interstitial pneumonia), accompanied by asbestos bodies in histologic section
  • Author's view: with a good exposure history and compatible clinical, functional and radiographic findings, asbestosis can be regarded as established without histologic examination
  • Author's view: interstitial fibrosis without asbestos bodies allows only a diagnosis of fibrosis of unknown cause
  • Author's proposed terminology for asbestos-related small-airway lesions
  • Author knew of no pathologic way to attribute a cigarette smoker's lung cancer partly or wholly to asbestos
  • Author's view: the main difficulty with mesothelioma is the pathologic diagnosis rather than the cause
  • Author's view: about a million chrysotile fibers per gram of dry lung is consistent with general-population background exposure
  • Author's view: about a million amosite or crocidolite fibers per gram almost certainly indicates substantial occupational exposure
  • Author's view: for mineral analysis, only lung tissue is of value, not tumor or plaque tissue
• The authors' conclusion: The author concluded that attributing asbestos-induced cancers has no easy scientific solution at present, and that a legislated or administrative remedy may be needed

Topics

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

Related studies

• Mineralogic parameters related to amosite asbestos-induced fibrosis in humans — A. Churg, J. Wright, et al. (1990)
• Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group — A.N. Husain, T. Colby, et al. (2013)
• Asbestos-related lung cancer and malignant mesothelioma of the pleura: selected current issues — S. Markowitz (2015)
• Current issues in malignant pleural mesothelioma evaluation and management — J. Ai, J.P. Stevenson (2014)
• Current issues regarding the pathobiology of asbestosis: a chronologic perspective — E. Kagan (1988)
• Compensation for environmental asbestos-related diseases in South Africa: a neglected issue — N. Ndlovu, J.T. Naude, et al. (2013)

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