Legal claims for malignant mesothelioma: dealing with all cases

Our plain-English summary of Legal claims for malignant mesothelioma: dealing with all cases, by S. van der Bij, P. Baas, M.J. van de Vijver, et al (Lung Cancer, 2013).

The study

• Authors: S. van der Bij, P. Baas, M.J. van de Vijver, B.A. de Mol, J.A. Burgers
• Journal: Lung Cancer
• Published: 2013;80(2):153-8
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Apart of medical reasons, a definitive diagnosis of malignant mesothelioma may be required as a basis for a claim of financial compensation although a pathological source of conclusive evidence is missing. Clinical assessment of all available data is then the only option to come to a final conclusion. We evaluated the diagnostic work-up of a large cohort of Dutch patients who applied for financial compensation due to mesothelioma. We determined how often a pathological or clinical diagnosis can be made, and which factors are associated with making the final diagnosis malignant mesothelioma.

Methods: A flow diagram of the diagnostic work-up was constructed for patients that applied to the Dutch institute for asbestos victims between 2005 and 2008 (N=1498). Both pathological and clinical factors that may influence the diagnostic outcome were assessed.

Results: In 97 of the 1498 patients (6%) no pathologic diagnosis could be established because of an uncertain diagnosis (N=54), inadequate (N=22) or unavailable tumor samples (N=21). A final pathological diagnosis of malignant mesothelioma could most often be made when biopsy samples were available compared to those in whom only cytological material was available. In patients in who no conclusive diagnosis could be made, clinical assessment was performed. Eighty percent of patients (66/83) who were clinically assessed were considered to have mesothelioma. None of the clinical features analyzed were strongly associated with a confirmed diagnosis of malignant mesothelioma.

Discussion: Our study shows that only in a small number of the patients who applied no pathologic diagnosis could be obtained. Based on judgment of clinical experts in the majority of these cases a near to certain diagnosis could be made. Moreover, it is reasonable to obtain biopsy material from patients to increase the chance to obtain a confirmed diagnosis. Therefore, it is important to refer patients early for diagnostic procedures.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

In plain English

This study reviewed how malignant mesothelioma was diagnosed in 1498 people who applied for compensation to the Dutch institute for asbestos victims between 2005 and 2008. A national panel of pathologists reviewed samples from 1477 applicants, confirming mesothelioma in 1308 (89%) and ruling it out in 93 (6%), most of whom had lung carcinoma. For 97 applicants (6%), no pathologic diagnosis was possible because the diagnosis was uncertain, samples were inadequate, or samples were unavailable. A diagnosis was established in 74% of those with only cytological material, versus 97% of those with other material such as biopsies. Of 83 patients then reviewed by a panel of lung specialists, 66 (80%) were judged to have mesothelioma. In an analysis that added 2000–2004 cases, several features were linked to this judgment, but none could decide it alone; asbestos exposure was not significantly linked. The authors concluded that biopsy material gives the best chance of a confirmed diagnosis, with clinical assessment an option when pathology is insufficient.

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 evaluation of the diagnostic work-up (flow diagram, cross tabulations with chi-square tests and risk ratios) of all applicants to a national compensation institute
• Who was studied: 1498 patients with apparent malignant mesothelioma who applied for financial compensation to the Dutch institute for asbestos victims, The Netherlands, 2005–2008. The clinical-feature analysis also added 153 patients clinically assessed in 2000–2004.
• Exposure: No fiber types, products, jobs or doses were studied. Asbestos exposure (yes/no) was one of the clinical features the clinical expert panel considered.
• Main results:
  • Of the 1477 patients with pathologic material, the Dutch National Mesothelioma Panel of pathologists confirmed malignant mesothelioma (category I or II) in 1308 (89%).
  • The pathologists definitely ruled out mesothelioma (category IV) in 93 (6%) patients.
  • Among patients in whom the pathologists excluded mesothelioma, 85% were diagnosed with carcinoma of the lung.
  • In 97 (6%) of the 1498 applicants no pathologic diagnosis could be established. The reasons were an uncertain diagnosis, inadequate samples, or no pathologic material being available (21 patients).
  • Among the 113 patients with only cytological material, a diagnosis (category I, II or IV) was established in 74%.
  • Among the 1364 patients with other (additional) material, a diagnosis was established in 1317 (97%). For the comparison of the two groups the chi-square was 105.5, p less than 0.001.
  • Of the 83 patients from 2005–2008 who underwent clinical assessment by the Mesothelioma Clinical Expert Panel of pulmonologists, 66 (80%) were judged to have malignant mesothelioma.
  • Clinically assessed patients whose pathologic material existed but gave no established diagnosis were more often judged to have mesothelioma (54 of 62, 87%) than patients with no pathologic material (12 of 21, 57%).
  • In the pooled 2000–2008 group of clinically assessed patients, almost all clinical features were significantly associated with a confirmed diagnosis. The exceptions were age, gender, smoking status, asbestos exposure and calcified pleural mass.
  • For asbestos exposure in the pooled clinically assessed group: 140 of 181 exposed patients (77%) and 37 of 57 non-exposed patients (65%) received a mesothelioma diagnosis (risk ratio 1.19, 95% CI 0.97–1.46, not statistically significant).
  • None of the clinical features was associated with a confirmed diagnosis strongly enough to determine the diagnosis on its own.
• The authors' conclusion: The authors concluded that obtaining biopsy material gives the highest chance of a confirmed diagnosis, that patients should be referred early for diagnostic procedures, and that clinical assessment could be an option when pathologic material is not sufficient.
• Limitations the authors state:
  • The authors state that how well clinical assessment by experts identifies patients with malignant mesothelioma still needs to be determined.
  • The authors note that the clinical signs of malignant mesothelioma are usually non-specific.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Biopsy.

Related studies

• Mesothelioma incidence surveillance systems and claims for workers' compensation. Epidemiological evidence and prospects for an integrated framework — A. Marinaccio, A. Scarselli, et al. (2012)
• Asbestos, asbestos-related diseases, and compensation claims in The Netherlands — P. Swuste, A. Burdorf, et al. (2004)
• The James Hardie story: asbestos victims' claims evaded by manufacturer — B. Hills (2005)
• Cardiopulmonary function studies in workers dealing with asbestos and glasswool — J. Bjure, B. Soederholm, et al. (1964)
• Prognosis and prognostic factors of patients with mesothelioma: a population-based study — S. van der Bij, H. Koffijberg, et al. (2012)
• Fiber types, asbestos potency, and environmental causation: a peer review of published work and legal and regulatory scientific testimony — D. Egilman (2009)

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