Pleural thickening: its significance and relationship to asbestos dust exposure

Our plain-English summary of Pleural thickening: its significance and relationship to asbestos dust exposure, by S.M. Albelda, D.M. Epstein, W.B. Gefter, et al (The American Review of Respiratory Disease, 1982).

The study

• Authors: S.M. Albelda, D.M. Epstein, W.B. Gefter, W.T. Miller
• Journal: The American Review of Respiratory Disease
• Published: 1982;126(4):621-4
• Cited by: 41 articles, 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. 000654).

Abstract

The admission chest radiographs of 824 were screened for the presence of bilateral pleural thickening. Those patients with pleural thickening were scored according to the ILO classification of radiographs of the pneumoconioses. The prevalence of bilateral pleural thickening was high (6.2%) in these patients, of whom 67% had an environmental or occupational history suggestive of asbestos exposure. The predictive value of bilateral pleural thickening alone as an indicator of previous asbestos exposure was 67%. If one excludes known medical or surgical etiologies of pleural thickening then the predictive value increased to 81%. The radiographic detection of bilateral pleural thickening has a strong association with prior asbestos exposure.

In plain English

This study screened the admission chest X-rays of 824 consecutive patients at the Hospital of the University of Pennsylvania over 2 months for thickening of the lung lining (pleura) on both sides of the chest, and examined its link to asbestos exposure. Patients were interviewed about job, family and home history by an interviewer who did not know the X-ray findings. A comparison group of 32 men without thickening was also studied. Bilateral pleural thickening was found in 52 (6.2%) of the 824 patients: 50 of 299 men and 2 of 525 women. Compared with the comparison group, more of those with thickening reported at least possible asbestos exposure (67% versus 34%) and definite or probable exposure (44% versus 18%), both significant at p less than 0.01. Nine of the 52 had possible causes other than asbestos, and eight had no identifiable cause. Bilateral thickening alone predicted past asbestos exposure in 67% of cases. This rose to 81% when other medical or surgical causes were excluded. The authors concluded that bilateral pleural thickening on X-ray, though not a sensitive screening test, is highly predictive of past asbestos exposure.

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: Hospital screening study of consecutive admission chest radiographs, with blinded exposure interviews and a randomly chosen age- and sex-matched control group without pleural thickening
• Who was studied: 824 consecutive patients (299 men, 525 women) admitted over 2 months to the Hospital of the University of Pennsylvania, Philadelphia; the control group was 32 men without pleural thickening, chosen from admissions
• Exposure: Asbestos exposure from a detailed occupational, family and residential interview, classed as definite, probable (mainly shipyard or insulation workers), possible, or unlikely; fiber types were not specified
• Main results:
  • Bilateral pleural thickening was present in 52 (6.2%) of the 824 patients screened
  • Bilateral pleural thickening was found in 50 of 299 men (16.7%) and 2 of 525 women (0.4%)
  • At least possible asbestos exposure was reported in 67% of the pleural thickening group and 34% of the control group (p < 0.01)
  • Definite or probable asbestos exposure was reported in 44% of the pleural thickening group and 18% of the control group (p < 0.01)
  • Among the 52 with bilateral thickening, 9 (17%) had potential causes other than asbestos, and 8 (15%) had no discernible cause
  • Four patients (0.5%) had pleural calcification with plaques. All had had definite heavy asbestos exposure more than 20 years earlier
  • Pleural thickening combined with either pleural calcification or interstitial lung disease had a predictive value of 100% for a history of asbestos exposure in this series
  • No patient whose asbestos exposure occurred within the last 20 years showed pleural thickening greater than Grade a (less than 5 mm wide)
  • Bilateral pleural thickening alone had a predictive value of 67% for asbestos exposure, rising to 81% when other medical or surgical causes were excluded
• The authors' conclusion: The authors concluded that, although not a sensitive screening test, bilateral pleural thickening on chest X-ray is highly predictive of past asbestos exposure
• Limitations the authors state:
  • The authors noted that bilateral pleural thickening is not a sensitive screening test
  • The authors noted that true pleural thickening can be hard to tell apart on X-ray from fat deposits or muscle shadows

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Thickening, Chest X-Ray, Bilateral, ILO Classification, Occupational History, Asbestos Exposure.

Related studies

• Pleural thickening: its significance and relationship to asbestos dust exposure — T. Rodman, M.S. Rodman (1983)
• Diffusing capacity and forced vital capacity in 5,003 asbestos-exposed workers: relationships to interstitial fibrosis (ILO profusion score) and pleural thickening — A. Miller, R. Warshaw, et al. (2013)
• Bilateral pleural thickening: a manifestation of asbestos dust exposure — E.N. Sargent, J. Gordonson, et al. (1978)
• Thickening of pulmonary interlobar fissures: exposure-response relationship in crocidolite and amosite miners — A. Solomon, L.M. Irwig, et al. (1979)
• Risk and significance of chest radiograph and pulmonary function abnormalities in an elderly cohort of former nuclear weapons workers — M.A. Mikulski, P.G. Hartley, et al. (2011)
• Asbestos-related pleural thickening: effect of threshold criteria on interpretation — R. Greene, C. Boggis, et al. (1984)

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