Surgical and pathologic aspects of asbestosis

Our plain-English summary of Surgical and pathologic aspects of asbestosis, by W.F. Sasser, W.A. Bari (Southern Medical Journal, 1981).

The study

• Authors: W.F. Sasser, W.A. Bari
• Journal: Southern Medical Journal
• Published: 1981;74(10):1178-9, 1185
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002019).

Abstract

We studied 12 patients with occupational exposure to asbestos to evaluate the pulmonary diseases that result from protracted exposure to this fibrogenic and oncogenic fiber. The spectrum of diseases includes diffuse interstitial fibrosis, bronchogenic carcinoma, and malignant mesothelioma. Cigarette smoking is found to be a cocarcinogen with asbestos. Because of the impairment of pulmonary function in these patients, surgery plays a limited role in their management.

In plain English

This article described 12 patients in whom asbestos or ferruginous bodies were found after a chest (thoracic) operation. The authors were from the surgery and pathology departments of St. John's Mercy Medical Center in St. Louis. The article did not say when the patients were studied or treated. All the patients were men aged 52 to 78. Each had worked in an asbestos-related job, such as asbestos worker, insulation worker or pipefitter, for at least 20 years. Seven had asbestosis, two had malignant mesothelioma and three had carcinoma. Four of the seven with asbestosis died of infection on top of severe lung insufficiency. Both mesothelioma patients were nonsmokers; one had died and the other was living with the disease. All three carcinoma patients had died. Their poor lung function ruled out curative surgery, and radiation therapy did not succeed. All patients presented with shortness of breath (dyspnea). The authors concluded that the outlook in this small series was grim and that surgery plays a limited role. The smoking risk figure in the article came from earlier New York studies, not from these 12 patients.

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 series: a clinical and pathological description of 12 patients who had chest surgery
• Who was studied: 12 men aged 52 to 78 years in whom asbestos or ferruginous bodies were found after a thoracic surgical procedure. The authors were at St. John's Mercy Medical Center, St. Louis. The article does not say when the patients were studied or treated. By diagnosis: 7 had asbestosis, 2 had malignant mesothelioma and 3 had carcinoma.
• Exposure: Occupational asbestos exposure of at least 20 years, with more than half exposed for 30 years or more. Occupations listed in the table were asbestos worker, insulation worker, pipefitter and chemical worker. The fiber types the patients were exposed to were not stated.
• Main results:
  • In the seven patients with asbestosis, surgery was done to establish the diagnosis, to rule out malignancy and for workmen's compensation purposes. Thickened pleura was removed to try to improve impaired lung function.
  • Four of the seven patients with asbestosis died of infection superimposed on severe pulmonary insufficiency.
  • The two patients with malignant mesothelioma were nonsmokers and had surgery for diagnosis. Pleurectomy had little effect on the course of the disease. One was dead and the other was living with disease.
  • All three patients with carcinoma were dead. Because of marked pulmonary insufficiency, no curative surgery was feasible. All were given radiation therapy without success.
  • All patients in the series presented with dyspnea. Pulmonary insufficiency complicated by recurrent infection was the most frequent cause of death in the patients with interstitial lung disease.
• The authors' conclusion: The authors concluded that the outlook in their small series of asbestos-associated disease had been grim, and that impaired lung function limits the role of surgery. The article's abstract also states that cigarette smoking is a cocarcinogen with asbestos; the smoking risk figure in the text comes from earlier studies by other researchers.
• Limitations the authors state:
  • The authors described the study as a small series.

Topics

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

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Fibrogenic, Interstitial Fibrosis, Bronchogenic Carcinoma, Malignant Mesothelioma.

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• Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group — A.N. Husain, T.V. Colby, et al. (2018)
• Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group — A.N. Husain, T. Colby, et al. (2013)
• The Pathologic Peritoneal Cancer Index (PCI) Strongly Differs From the Surgical PCI in Peritoneal Metastases Arising From Various Primary Tumors — A. Bhatt, Y. Yonemura, et al. (2020)
• Asbestosis: high-resolution CT-pathologic correlation — M. Akira, S. Yamamoto, et al. (1990)
• 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)

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