Noninvasive detection of early asbestos-related disease of the thorax: algorithmic analysis of radiographic, nuclear, and serologic tests

Our plain-English summary of Noninvasive detection of early asbestos-related disease of the thorax: algorithmic analysis of radiographic, nuclear, and serologic tests, by S.D. Rockoff, A.M. Schwartz (Annals of the New York Academy of Sciences, 1991).

The study

• Authors: S.D. Rockoff, A.M. Schwartz
• Journal: Annals of the New York Academy of Sciences
• Published: 1991;643:121-32
• Type of article: Review
• Cited by: 1 article, 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. 004495).

Abstract

Improved imaging techniques may assist in the diagnosis of early asbestosis, such as could occur from "asbestos in place." These include (1) increased visualization of visceral pleural thickening, (2) high-resolution computed tomography (HRCT), and (3) gallium scanning, combined with evidence of serum markers indicating inflammation-associated pulmonary collagen formation. Combining these imaging and serum test observations with a clinically useful algorithmic approach may permit the diagnosis of "early" asbestosis, which is not now possible from the individual test results or from an unweighted combination of such data.

In plain English

This paper was a symposium presentation that reviewed noninvasive ways to detect "early" asbestosis. The authors defined "asbestos in place" exposure as long-term low-dose and/or short-term high-dose exposure to asbestos dust. They argued that the ILO chest X-ray classification is poorly suited to finding early disease. They summarized their earlier study of 220 asbestos-exposed men and 100 age-matched controls. In the exposed workers, a 50% probability of visceral pleural (fissural) thickening came 21 years after first exposure, compared with 31 years for pleural plaques. About 54% of exposed workers and 16% of controls had visceral pleural thickening, so the authors called it a useful but not diagnostic sign. Three individual cases were illustrated. One asbestos-industry worker had fissural thickening confirmed by CT, along with calcified pleural plaques. Another asbestos worker's biopsy showed visceral pleural thickening, interstitial fibrosis and ferruginous bodies. A secretary's chest X-ray was normal, but HRCT showed plaques and minimal fibrosis. Gallium scanning and serum markers were discussed from other investigators' work. The authors concluded that combining these tests in a weighted algorithm may permit diagnosis of early asbestosis.

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 (symposium presentation) of noninvasive diagnostic methods. It includes illustrative case examples and a summary of the authors' own earlier published study. No new study was reported.
• Who was studied: No study population of its own. The paper summarized the authors' earlier study of 220 asbestos-exposed workers and 100 age-matched controls, all male. It also illustrated individual cases: an asbestos-industry worker (Figure 2), a 59-year-old asbestos worker with shortness of breath (Figures 3 and 4), and a nonsmoking woman in her 60s who worked as a secretary (Figure 7).
• Exposure: Exposure to "asbestos in place", which the authors defined as long-term low-dose and/or short-term high-dose exposure to asbestos dust. No fiber type was named. In the secretary's case, asbestos had been flaking off pipes and ceiling tiles in her workplace for more than 30 years.
• Main results:
  • From the authors' earlier study: in asbestos-exposed persons, a 50% probability of visceral pleural (fissural) thickening occurred at 21 years after initial exposure.
  • From the same earlier study: a 50% probability of pleural plaque formation occurred about 31 years after initial exposure, roughly 10 years later than fissural thickening.
  • Visceral pleural thickening was found in some 16% of the control group and approximately 54% of the asbestos-exposed group.
  • Among the asbestos workers, visceral pleural thickening (54.5%) was more common than pleural plaque formation (38.2%).
  • Case illustration (Figure 2): an asbestos-industry worker had fissural thickening verified by CT, with calcified pleural plaques also noted.
  • Case report: in the 59-year-old asbestos worker, thoracoscopic biopsy showed marked visceral pleural thickening, with interstitial fibrosis and ferruginous bodies beneath it.
  • Case report: in the secretary with "asbestos in place" exposure, the plain chest X-ray was considered normal, but HRCT showed minimal intraparenchymal bands and pleural plaques.
• The authors' conclusion: The authors concluded that combining imaging and serum test findings with an algorithmic approach may permit the diagnosis of "early" asbestosis. In their view, this is not now possible from the individual tests or from an unweighted combination of them.
• Limitations the authors state:
  • The authors stated that visceral pleural thickening lacks specificity: it also appeared in some of the control group, so it is a useful rather than a diagnostic sign.
  • The authors noted that some controls with visceral pleural thickening may themselves have been exposed to "asbestos in place".
  • The authors stated that gallium lung scanning is nonspecific and only indicates active inflammation.

Topics

Medical terms in this study, explained in our Lexicon: Thorax, Pleural Thickening, High-Resolution CT (HRCT), Inflammation, Collagen.

Related studies

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• Asbestos-related chest diseases: plain radiographic findings — W.T. Miller, W.B. Gefter, et al. (1992)
• Asbestos-related cancer in naval personnel: findings from participants in the British nuclear tests 1952-1967 — R.T. Gun, G.M. Kendall (2023)
• Inter-reader variability in chest radiography and HRCT for the early detection of asbestos-related lung and pleural abnormalities in a cohort of 636 asbestos-exposed subjects — E. Ochsmann, T. Carl, et al. (2010)
• Early detection of interstitial lung disease in asbestos exposed non-smoking workers by mid-expiratory flow rate and high resolution computed tomography — Z. Dujić, J. Tocilj, et al. (1991)
• Cigarette smoke makes airway and early parenchymal asbestos-induced lung disease worse in the guinea pig — V. Tron, J.L. Wright, et al. (1987)

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