Occam's Razor versus Hickam's Dictum

Our plain-English summary of Occam's Razor versus Hickam's Dictum, by T.A. Newman, J.E. Takasugi, G. Matute-Bello, et al (Annals of the American Thoracic Society, 2017).

The study

• Authors: T.A. Newman, J.E. Takasugi, G. Matute-Bello, J.B. Virgin, L.M. Backhus, R. Adamson
• Journal: Annals of the American Thoracic Society
• Published: 2017;14(11):1709-1713
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article is a case conference describing a single patient. He was a 76-year-old man with an approximately 100-pack-year smoking history who had handled asbestos without a respirator for about 25 years while working as a plumber. He had 2 months of cough and sputum. CT imaging showed a 6-cm mass in the left lower lobe, several pleural nodules on the left, and a nodule inside an airway of the right lower lobe. Biopsies of the right airway nodule showed non-small cell lung cancer. Cancer on the left side would have ruled out surgery for the right-sided cancer, so the left-sided lesions were biopsied surgically. The left lung mass showed mild emphysema with interstitial fibrosis and no cancer. The pleural lesion was a dense fibrous plaque with no cancer. After removal of the right middle and lower lobes, the final diagnoses were stage IA bronchial squamous cell carcinoma, pleural plaques, and rounded atelectasis, a type of localized lung collapse that appears as a mass on CT. The authors concluded that all three conditions are potential consequences of asbestos exposure. At follow-up, CT showed no evidence of cancer recurrence.

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: case report (case conference)
• Who was studied: One 76-year-old man referred to a pulmonary clinic with 2 months of cough and sputum; the article does not state where or when he was seen
• Exposure: Handled asbestos without a respirator for approximately 25 years while working as a plumber (fiber type not stated); also an approximately 100-pack-year smoking history
• Main results:
  • CT of the chest showed a 6-cm left lower lobe mass, several noncalcified pleural nodules on the left, and an endobronchial nodule in the right lower lobe superior segment
  • On PET-CT, the right endobronchial nodule had a standardized uptake value of 10.3 and the left lower lobe mass had a value of 2.6
  • Biopsy of the right endobronchial nodule showed non-small cell lung cancer
  • The left lower lobe mass biopsy showed mild emphysema with interstitial fibrosis and no evidence of cancer
  • The pleural biopsy showed a dense fibrous plaque and no evidence of cancer
  • After bilobectomy, pathology showed a papillary squamous bronchial carcinoma with minimal invasion into the bronchus wall
  • The sampled parabronchial and mediastinal lymph nodes were not involved
  • Final diagnoses were stage IA bronchial squamous cell carcinoma, pleural plaques, and rounded atelectasis
  • At follow-up, surveillance CT showed no evidence of cancer recurrence
• The authors' conclusion: The authors concluded that the patient's three distinct conditions (squamous cell lung cancer, rounded atelectasis, and asbestos-related pleural plaques) are all potential consequences of asbestos exposure

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening.

Related studies

• Cervical endometriosis associated with malignant pleural mesothelioma mimicking cervical cancer--Occam's razor or the "third man" — J.B. Engel, S. Heuer, et al. (2011)
• Occam's razor pares the choice among statistical models — K.J. Rothman (1978)
• Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases — M. Metintas, I. Ucgun, et al. (2002)
• Rounded atelectasis and its association with asbestos-induced pleural disease — R.A. Mintzer, R.M. Gore, et al. (1981)
• Rounded atelectasis. Clinical experience with 74 patients — G. Hillerdal (1989)
• Rounded atelectasis associated with pulmonary lymphangioleiomyomatosis — K. Kishi, S. Homma, et al. (2005)

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