Gallium lung scanning and bronchoalveolar lavage in crocidolite-exposed workers

Our plain-English summary of Gallium lung scanning and bronchoalveolar lavage in crocidolite-exposed workers, by A.A. Hayes, B. Mullan, F.T. Lovegrove, et al (Chest, 1989).

The study

• Authors: A.A. Hayes, B. Mullan, F.T. Lovegrove, A.H. Rose, A.W. Musk, B.W. Robinson
• Journal: Chest
• Published: 1989;96(1):22-6
• Cited by: 9 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. 000090).

Abstract

Gallium lung scanning is widely used to evaluate pulmonary inflammation in patients with interstitial lung disease but has not previously been reported in crocidolite-exposed workers. In order to characterize the pulmonary inflammation caused by crocidolite inhalation, GLS and BAL findings were related to chest x-ray film changes graded according to the ILO classification of roentgenograms of pneumoconioses. In individuals with roentgenographic evidence of asbestosis (CXR greater than or equal to 1/0, n = 15), 13 had a positive GLS and 13 had an abnormal BAL. In asbestos-exposed individuals with equivocal chest x-ray film changes (CXR 0/1, n = 12), six had a positive GLS and six had BAL changes (both GLS and BAL abnormal in three). In individuals with a normal chest x-ray film (CXR 0/0 n = 8), two had a positive GLS and two BAL changes (both abnormal in 1). These data demonstrate that most subjects with crocidolite-induced asbestosis have an abnormal GLS and BAL. In addition, many individuals with asbestos exposure and equivocal or no chest x-ray film changes have an abnormal GLS and/or BAL, suggesting the presence of active subclinical pulmonary inflammation in these individuals.

In plain English

This Western Australian study examined 35 consecutive former workers from the Wittenoom crocidolite (blue asbestos) mining industry who had been referred for investigation of possible asbestosis. Each had a gallium lung scan (a nuclear scan that shows inflammation), bronchoalveolar lavage (lung washing through a bronchoscope) and lung function tests. Chest x-rays put 15 workers in an asbestosis group, 12 in an equivocal group and 8 in a normal group. In the asbestosis group, 13 of 15 (87 percent) had increased gallium uptake and 13 had abnormal lavage. In the equivocal group, 6 of 12 had abnormal scans and 6 abnormal lavage. In the normal group, 2 of 8 had abnormal scans and 2 abnormal lavage. Mean gallium scores were 2.1, 1.5 and 1.2 in these three groups, against 0.7 in 11 unexposed comparison patients. Scan and lavage results did not always agree. The authors concluded that many exposed workers with equivocal or normal x-rays had abnormal scans or lavage, which they took to suggest active subclinical lung inflammation.

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: Clinical cross-sectional study of consecutively referred workers, each tested once with gallium lung scanning, bronchoalveolar lavage and lung function tests. Gallium results were compared with an unexposed control group.
• Who was studied: 35 former Wittenoom crocidolite workers in Western Australia, grouped by ILO chest x-ray grading: 15 with asbestosis (grade 1/0 or greater), 12 with equivocal changes (0/1) and 8 with normal x-rays (0/0). The control group was 11 people with no asbestos exposure or chest disease who were having gallium scans for suspected hip, knee or ankle infection.
• Exposure: Crocidolite from work in the Wittenoom crocidolite-mining industry. Exposure details came from occupational history records. Exposure lasted longest in the asbestosis group and was similar in the equivocal and normal x-ray groups.
• Main results:
  • Asbestosis group: 13 of 15 (87 percent) had increased gallium uptake in the lungs.
  • Asbestosis group: mean gallium grade was 2.1 plus or minus 0.2. This was reported as p less than 0.05 compared with exposed workers whose x-rays showed equivocal changes.
  • Asbestosis group: lavage abnormalities were found in 13 of 15 (87 percent).
  • Asbestosis group: scan and lavage results did not always agree. Two workers had increased gallium uptake with normal lavage, and two had abnormal lavage with a normal scan.
  • Equivocal x-ray group (n = 12): 6 (50 percent) had increased gallium uptake.
  • Equivocal x-ray group: mean gallium grade was 1.5 plus or minus 0.2, reported as p less than 0.05 compared with control subjects.
  • Equivocal x-ray group: 6 had lavage abnormalities. Both tests were abnormal in 3 workers and both were normal in 3.
  • Normal x-ray group (n = 8): 2 (25 percent) had increased gallium uptake. Mean grade was 1.2 plus or minus 0.2, reported as p less than 0.05 compared with control subjects.
  • Normal x-ray group: lavage changes were found in 2 (25 percent). Both tests were abnormal in 1 worker.
  • Unexposed control group (n = 11): gallium uptake was graded 0.7 plus or minus 0.1.
  • Lung function abnormalities were not marked in any group. They were greatest in the asbestosis group.
  • Across groups, gallium uptake did not appear to be associated with the percentages of the different cell types found in lavage fluid.
• The authors' conclusion: The authors concluded that most workers with crocidolite-induced asbestosis had abnormal gallium scans and lavage, indicating active lung inflammation. They also concluded that many exposed workers with equivocal or normal chest x-rays had increased gallium uptake or abnormal lavage, implying active subclinical lung inflammation.
• Limitations the authors state:
  • The authors noted that a gallium scan cannot tell what kind of inflammation lies behind an abnormal result.

Mines named here

Asbestos mines this study is about. Each mine's page says who ran it, when it worked, and what it produced.

• Wittenoom, Western Australia

All asbestos mines

Topics

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

Medical terms in this study, explained in our Lexicon: Bronchoalveolar Lavage (BAL), Crocidolite, Inflammation, Interstitial Lung Disease, Chest X-Ray, ILO Classification, Asbestos Exposure.

Related studies

• Bronchoalveolar lavage analysis, gallium-67 lung scanning and soluble interleukin-2 receptor levels in asbestos exposure — G.L. Delclos, D.G. Flitcraft, et al. (1989)
• Bronchoalveolar lavage and 99mTc-DTPA clearance as prognostic factors in asbestos workers with and without asbestosis — N. al Jarad, A.R. Gellert, et al. (1993)
• Bronchoalveolar lavage fluid cellular profile in workers exposed to chrysotile asbestos — F.P. Kokkinis, D. Bouros, et al. (2011)
• Alveolitis of pulmonary asbestosis. Bronchoalveolar lavage studies in crocidolite- and chrysotile-exposed individuals — B.W. Robinson, A.H. Rose, et al. (1986)
• Changes in surfactant in bronchoalveolar lavage fluid after hemithorax irradiation in patients with mesothelioma — M. Hallman, P. Maasilta, et al. (1990)
• Detection of lipid peroxidation in lung and in bronchoalveolar lavage cells and fluid — J.M. Petruska, S.H. Wong, et al. (1990)

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