Pathology of Asbestosis: An Update of the Diagnostic Criteria Response to a Critique

Our plain-English summary of Pathology of Asbestosis: An Update of the Diagnostic Criteria Response to a Critique, by V. Roggli, A.R. Gibbs, R. Attanoos, et al (Archives of Pathology & Laboratory Medicine, 2016).

The study

• Authors: V. Roggli, A.R. Gibbs, R. Attanoos, A. Churg, H. Popper, B. Corrin, T. Franks, F. Galateau-Salle, J. Galvin, P. Hasleton, K. Honma
• Journal: Archives of Pathology & Laboratory Medicine
• Published: 2016;140(9):950-2
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This article was the reply of the 2010 Asbestosis Committee of the College of American Pathologists and the Pulmonary Pathology Society to a published critique by Hammar and Abraham of the committee's 2010 update of the pathologic diagnostic criteria for asbestosis. The authors explained that the committee was formed after a 2007 request to update the 1982 standards. It included 12 pathologists from 8 countries on 4 continents, plus a radiologist, and limited its work to asbestosis.

The authors gave a point-by-point response. They stated that the committee decided unanimously to exclude fibrosis confined to bronchiolar walls from grade 1 asbestosis. Their reasons were that such fibrosis typically gives obstructive rather than restrictive lung function findings, occurs with other dusts, and was seen in 23% of 254 British persons without occupational exposure. They held that alveolar septal fibrosis is necessary for the diagnosis.

They defended the requirement of 2 asbestos bodies per square centimeter, which originated in the 1997 Helsinki criteria. They stated that it corresponds to 800, not 4000, asbestos bodies per gram of wet lung, which is 40 times the upper limit of background.

They said iron stains should be decided case by case. Cases with low asbestos body counts could still qualify by fiber analysis if the fiber burden exceeded the 5th percentile of the asbestosis range. Laboratories should compare results within their own methods. Finally, they stated that medical-legal issues were not the committee's focus and that NIOSH could endorse the 2010 document if it chose.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article is not a new study. It is a written response by members of the committee that published updated pathology criteria for diagnosing asbestosis in 2010, answering a published critique of those criteria point by point. The authors stated that removing fibrosis confined to the bronchiolar walls from the definition of grade 1 asbestosis was a unanimous committee decision, and that fibrosis of the alveolar septal walls is necessary for a pathologic diagnosis. They said the requirement of 2 asbestos bodies per square centimeter of lung tissue was first proposed by the 1997 Helsinki consensus report. They said this corresponds to 800 asbestos bodies per gram of wet lung, not the 4000 the critique stated, and described 800 as 40 times the upper limit of background. They said the committee reached no consensus on routine use of iron stains. Patients who form few asbestos bodies could still qualify if their lung fiber burden exceeded the 5th percentile of the asbestosis range. The authors concluded that the 2-per-square-centimeter requirement is consistent with a threshold for 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: Commentary: a point-by-point response to a published critique of the 2010 asbestosis diagnostic criteria. No new data were collected.
• Who was studied: Not applicable: no patients or subjects were studied. The authors are members of the 2010 committee, which was made up of 12 pathologists from 8 countries plus a radiologist.
• Exposure: No exposure was studied directly. The article discusses pathologic criteria for asbestosis, including asbestos body counts and lung fiber burden, and how chrysotile forms asbestos bodies compared with the amphiboles.
• Main results:
  • The authors stated that fibrosis of the alveolar septal walls is necessary for a pathologic diagnosis of asbestosis. Fibrosis confined to the bronchiolar walls was removed from the grade 1 definition by unanimous committee decision.
  • The authors stated that the requirement of 2 asbestos bodies per square centimeter did not originate with the 2010 committee. It was proposed by the 1997 Helsinki consensus report and reaffirmed at the 2014 Helsinki meeting.
  • The critique said 2 asbestos bodies per square centimeter correspond to 4000 asbestos bodies per gram of wet lung tissue. The authors said, citing earlier work, that the figure is 800 per gram of wet lung.
  • The authors stated that 800 asbestos bodies per gram is 40 times the upper limit of the background range of asbestos body counts.
  • The authors stated that chrysotile miners and millers with heavy exposures sufficient to cause asbestosis do have asbestos bodies in histologic sections.
  • The authors stated that the committee did not recommend iron stains in all cases of interstitial fibrosis. They said this decision should be made case by case, and that the committee reached no consensus on routine use of iron stains.
  • Some patients form few asbestos bodies and would not meet the 2 per square centimeter criterion. The authors stated that, under the 2010 criteria, such cases could still qualify as asbestosis if lung fiber burden exceeded the 5th percentile for the asbestosis range.
  • The authors stated, citing their own earlier work, that the severity of fibrosis in asbestosis correlates best with amphibole fiber counts measured by scanning electron microscopy, not with asbestos body counts by light microscopy.
  • The authors stated that medical-legal issues were not the focus of the committee.
• The authors' conclusion: The authors concluded that the requirement for 2 asbestos bodies per square centimeter is consistent with a threshold for asbestosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Pathology, Fibrosis, Restrictive Lung Disease, Occupational Exposure, Asbestos Bodies, Helsinki Criteria, Iron Stain (Prussian Blue), Fiber Burden.

Related studies

• Commentary on pathologic diagnosis of asbestosis and critique of the 2010 Asbestosis Committee of the College of American Pathologists (CAP) and Pulmonary Pathology Society's (PPS) update on the diagnostic criteria for pathologic asbestosis — S.P. Hammar, J.L. Abraham (2015)
• Dataset for Reporting of Malignant Mesothelioma of the Pleura or Peritoneum: Recommendations From the International Collaboration on Cancer Reporting (ICCR) — A. Churg, R. Attanoos, et al. (2016)
• Grade 4 asbestosis does not extend directly from the respiratory bronchiole to the peripheral lung — Y. Kawabata, T. Kasai, et al. (2018)
• Asbestos, asbestosis, and cancer: The Helsinki criteria for diagnosis and attribution. Critical need for revision of the 2014 update — X. Baur, H.J. Woitowitz, et al. (2017)
• Value of calretinin immunostaining in diagnostic pathology: a review and update — N.G. Ordóñez (2014)
• The diagnosis of mesothelioma by panels — W.T. McCaughey (1991)

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