Hazards of lung biopsy in asbestos workers

Our plain-English summary of Hazards of lung biopsy in asbestos workers, by Y. Lerman, J. Ribak, I.J. Selikoff (British Journal of Industrial Medicine, 1986).

The study

• Authors: Y. Lerman, J. Ribak, I.J. Selikoff
• Journal: British Journal of Industrial Medicine
• Published: 1986;43(3):165-9
• Type of article: Case report
• Cited by: 4 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. 001166).

Abstract

An investigation into the problem of the frequency and hazards of lung biopsy in asbestos workers was performed in two ways. The first study was into the frequency of lung biopsy among 2907 long term asbestos insulation workers in 1981-3 and the second was into the frequency of fatal complications of lung biopsy in 168 deaths from asbestosis among 2271 consecutive deaths of asbestos insulation workers 1967-76. Only 25 (0.9%) of the 2907 asbestos insulation workers reported having had either an open lung biopsy, a needle biopsy, or a transbronchial biopsy. Seven (24%) of these men suffered difficulties as a result of the biopsy. Lung biopsies had been performed on 14 of the 168 workers who died of asbestosis. Three (21%) of these 14 patients had died within 30 days of biopsy as a direct result of the procedure. In most cases there is no need for lung biopsy to establish a diagnosis of asbestosis; generally, it may be defined by history of exposure, clinical and radiological findings, and other well established non-invasive diagnostic procedures. Certainly, legal and compensation recommendation for biopsy should be considered with the possibility of death in mind. If biopsy is performed precautions should be taken, including adequate observation in hospital.

In plain English

This study looked at how often asbestos insulation workers had lung biopsies and what happened afterwards. It drew on a union cohort of 17 800 insulation workers in the United States and Canada. Of 2907 living members who had reached 30 years since first exposure and were examined in 1981-3, 25 reported an open lung, needle or transbronchial biopsy. Seven of these men reported difficulties afterwards, including pneumonia with abscess formation and pneumothorax. Among 2271 consecutive deaths in the cohort during 1967-76, 168 were from asbestosis, and 14 of those men had been biopsied. The authors reported that three of these 14 had died within 30 days of biopsy as a direct result of the procedure, and they described the three cases in detail. Among 486 lung cancer deaths and 63 pleural mesothelioma deaths, many had been biopsied, and none died as a result. The authors concluded that asbestosis can usually be diagnosed without invasive tests, that lung biopsy is not advised for "legal" reasons, and that hospital observation is recommended when biopsy is done.

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: Two-part study: a cross-sectional medical survey of living asbestos insulation workers, and a review of deaths in a mortality study, with case reports of three deaths after biopsy
• Who was studied: Members of the International Association of Heat and Frost Insulators and Asbestos Workers in the United States and Canada. The cohort was all 17 800 men on the union rolls on 1 January 1967. Of 5377 members still alive in 1981 who had reached 30 years from onset of exposure, 2907 were examined from November 1981 to October 1983. The mortality part covered 2271 consecutive deaths during 1967-76, of which 168 were from asbestosis.
• Exposure: Occupational asbestos exposure as insulation workers; fiber types not specified. The procedures studied were open lung biopsy, needle lung biopsy and transbronchial biopsy.
• Main results:
  • Among the 2907 examined living workers, 25 (0.9%) reported having had an open lung, needle or transbronchial biopsy.
  • Of these 25 biopsied living workers, seven (reported as 24%) suffered difficulties as a result of the biopsy.
  • Of the 12 living workers with open lung biopsy, one had pneumonia with abscess formation and four reported persistent pain at the operation site for many months. Of the four with needle biopsy, one developed pneumothorax. The nine with transbronchial biopsy had no complication.
  • Among the 168 men who died of asbestosis, 14 (8.3%) had undergone biopsy: four open lung, three transbronchial and seven needle.
  • Three (21%) of these 14 biopsied asbestosis patients died within 30 days of biopsy. The authors attributed these deaths directly to the procedure and called them fatal complications of lung biopsy.
  • The immediate causes of death in the three cases were: septic shock and arrhythmia after open lung biopsy; pneumothorax and subcutaneous emphysema after needle biopsy; and respiratory failure after pleural biopsy in a man with bilateral pleural effusion and rheumatic mitral valve disease.
  • Among the 2271 deaths, 179 (36%) of 486 fatal lung cancer cases and 38 (60%) of 63 pleural mesothelioma cases had been biopsied. None of these patients died as a result of these biopsies.
• The authors' conclusion: The authors concluded that the benefit of lung tissue should be weighed in each case against the risk of death after biopsy. In their view, biopsy is indicated when clinical findings and tests cannot rule out treatable conditions. It is not advised for "legal" reasons to confirm asbestosis, which can usually be diagnosed without invasive tests. They recommended adequate observation in hospital when biopsy is done.
• Limitations the authors state:
  • The authors stated that the biopsy frequency in this group, with more than 30 years since onset of exposure, is probably not representative of asbestos-exposed workers in general.
  • Fatal outcomes of biopsy could not be studied in the cross-sectional survey of living workers.
  • Complications among living workers were as reported by the patients themselves.

Topics

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

Medical terms in this study, explained in our Lexicon: Biopsy, Insulator, Needle Biopsy.

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