Diagnosis of asbestosis. Primum non nocere

Our plain-English summary of Diagnosis of asbestosis. Primum non nocere, by W.S. Beckett (Chest, 1997).

The study

• Author: W.S. Beckett
• Journal: Chest
• Published: 1997;111(5):1427-8
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a short opinion piece in Chest's "Debate in Print" section, replying to a preceding essay on asbestos-related disorders. It reported no new study data. The author asked whether asbestosis is overdiagnosed and whether more patients should have a lung biopsy. The author wrote that in 1997 there was no therapy for asbestosis. The author wrote that the United States lacked uniform diagnostic criteria and surveillance programs able to count the true number of cases. A separate study by Gaensler and colleagues, cited by the author, found an approximately 5% false-positive rate for the clinical criteria compared with lung biopsy. Citing another study, the author put thoracoscopic lung biopsy mortality at approximately 1%, adding that it might be approximately 0.5% in patients with mild asbestosis, and expected complications in 5 to 10% of patients. The author argued "emphatically no" to more biopsies: any overdiagnosis would come from failing to apply the clinical criteria, not from the criteria themselves, and biopsies would add surgical risk without clinical benefit. The author concluded that the current approach to diagnosis was already realistic.

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: Opinion/commentary (Debate in Print) replying to a preceding essay; no original study
• Who was studied: No study population; the commentary concerns asbestos-exposed patients who ask whether they have asbestosis
• Exposure: Inhaled asbestos in general (occupational); no specific fiber types named
• Main results:
  • The author stated that, as of 1997, there was no therapy to offer patients with asbestosis
  • The author stated that the United States lacked uniform diagnostic criteria (and surveillance programs) for estimating the true prevalence of asbestosis
  • A separate study cited by the author (Gaensler et al) found an approximately 5% false-positive rate for the clinical diagnostic criteria compared with lung biopsy
  • The author, citing another study, put the surgical mortality of thoracoscopic lung biopsy at approximately 1%
  • The author added that biopsy mortality might be lower, approximately 0.5%, in patients with mild asbestosis
  • The author expected surgical complications (morbidity) from such biopsies in 5 to 10% of patients
  • The author argued that any overdiagnosis would reflect a failure to apply the clinical criteria, not a failure of the criteria
• The authors' conclusion: The author argued against performing more lung biopsies to improve diagnostic specificity, and concluded that the current approach to asbestosis diagnosis was already realistic

Topics

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

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• 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 — S.P. Hammar, J.L. Abraham (2015)
• Radiographic readings for asbestosis: misuse of science--validation of the ILO classification — A. Miller (2007)
• Asbestos bodies or fibers and the diagnosis of asbestosis — M.L. Warnock, G. Wolery (1987)
• The clinical diagnosis of asbestosis in this century requires more than a chest radiograph — R.M. Ross (2003)
• Diagnosis of asbestosis by a time expanded wave form analysis, auscultation and high resolution computed tomography: a comparative study — N. al Jarad, B. Strickland, et al. (1993)

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