The significance of asbestos exposure in the diagnosis of mesothelioma: a 28-year experience from a major urban hospital

Our plain-English summary of The significance of asbestos exposure in the diagnosis of mesothelioma: a 28-year experience from a major urban hospital, by F.M. Hasan, G. Nash, H. Kazemi (The American Review of Respiratory Disease, 1977).

The study

• Authors: F.M. Hasan, G. Nash, H. Kazemi
• Journal: The American Review of Respiratory Disease
• Published: 1977;115(5):761-8
• Cited by: 28 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. 002235).

Abstract

A continued increase in the incidence of diffuse mesothelioma has been attributed to greater industrial use of asbestos but is also due in part to wider acceptance of this tumor by pathologists. In this retrospective study, the epidemiology, clinical presentation, and pathology of asbestos and non-asbestos-related mesothelioma from a major urban hospital were reviewed. Of the 36 cases of mesothelioma on file, 19 were not associated with exposure to asbestos. Although a retrospective study raises the possibility of inadequate occupational histories, the lack of history of asbestos exposure correlated with postmortem histology by light microscopy. When postmortem material was reviewed, evidence of asbestos exposure was present in all cases of mesothelioma with history of exposure to asbestos, and in no cases in which the patient denied history of asbestos exposure. Using strict histologic and histochemical criteria, the diagnosis of mesothelioma was confirmed in 8 of 9 patients with asbestos-related mesothelioma but in only 4 of 13 cases of non-asbestos-related mesothelioma. The diagnosis of diffuse methelioma is often difficult to make even wtih complete autopsy examinations. It should be entertained only with adherence to strict clinical and pathologic criteria, especially in women with no history to exposure to asbestos dust.

In plain English

This retrospective study reviewed all 36 patients coded with diffuse malignant mesothelioma at Massachusetts General Hospital, Boston, from 1945 through 1972. The authors classed 17 cases as asbestos related, 14 through shipyard trades. They classed 19 as not asbestos related: after documented inquiry, these patients denied using asbestos or working at the shipyard, and their job histories made exposure seem unlikely. Eight of the 9 women were in this group. Only 3 cases were diagnosed before 1960. Autopsy material was available for 22 patients, and one author re-examined it blind using strict tissue and staining criteria. Light microscopy found signs of asbestos exposure in all exposed patients examined but in none who denied exposure. Mesothelioma was confirmed in 8 of 9 asbestos-related cases but in only 4 of 13 non-asbestos-related cases. Of those 13, 6 were equivocal and 3 were adenocarcinomas of the ovary, lung and prostate. Mean survival was 7.4 months. The authors concluded that broadened diagnostic criteria may partly explain more frequent diagnoses. They cautioned against diagnosing it without careful autopsy, especially in women denying 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: Retrospective review of hospital records and autopsy material (case series from one hospital)
• Who was studied: All 36 patients with a coded diagnosis of diffuse malignant mesothelioma at Massachusetts General Hospital, Boston, 1945 through 1972. Autopsy material was available for 22 of them: 9 asbestos-related and 13 non-asbestos-related cases.
• Exposure: Occupational asbestos exposure judged from the records, mainly shipyard trades (most often fitting and insulating pipes). Cases were classed as non-asbestos related when, after documented inquiry, patients denied using asbestos or working at the shipyard and their occupational history made exposure seem unlikely. The fiber types in these patients were not identified.
• Main results:
  • Of the 36 cases, 17 were classed as asbestos related and 19 as not associated with asbestos exposure.
  • Of 9 women with diffuse mesothelioma, 8 were in the group that denied asbestos exposure.
  • Only 3 cases were diagnosed at the hospital before 1960.
  • In the asbestos-related cases, the time from last exposure to diagnosis ranged from 18 to 42 years.
  • On chest X-ray, pleural plaques were seen in 76 per cent of asbestos-related cases and in 28 per cent of patients who denied asbestos exposure.
  • On autopsy review by light microscopy, evidence of asbestos exposure was present in all cases with a history of exposure and in none of the cases where the patient denied exposure.
  • Using strict tissue and staining (PAS-D) criteria, mesothelioma was confirmed in 8 of 9 asbestos-related cases but in only 4 of 13 non-asbestos-related cases.
  • Among the 13 non-asbestos-related autopsy cases, 3 were diagnosed as adenocarcinoma of the ovary, lung and prostate. Six were labeled equivocal because of atypical staining or another primary tumor.
  • Among the 36 patients, mean survival from diagnosis to death was 7.4 months.
• The authors' conclusion: The authors concluded that the redefinition and broadening of diagnostic criteria may in part account for the more frequent diagnosis of mesothelioma. They cautioned against making the diagnosis without careful postmortem examination, especially in women who deny asbestos exposure.
• Limitations the authors state:
  • Because the study was retrospective, occupational histories may have been inadequate. The authors considered the exposure data complete in only two thirds of cases.
  • Light microscopy cannot detect very small asbestos fibers. The authors raised this possibility but judged it unlikely in the absence of interstitial fibrosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Mesothelioma, Epidemiology, Pathology, Histology, Autopsy.

Related studies

• Asbestos exposure and related neoplasia. The 28 year experience of a major urban hospital — F.M. Hasan, G. Nash, et al. (1978)
• Diffuse malignant pleural mesothelioma in an urban hospital: clinical spectrum and trend in incidence over time — K.E. Shepherd, L.C. Oliver, et al. (1989)
• Cytopathologic Diagnosis of Epithelioid and Mixed-Type Malignant Mesothelioma: Ten Years of Clinical Experience in Relation to International Guidelines — A. Hjerpe, S. Abd-Own, et al. (2018)
• Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital — B. Goslin, S. Sevak, et al. (2012)
• The 10-year experience of an academically affiliated occupational and environmental medicine clinic — L. Rosenstock, W. Daniell, et al. (1992)
• Experience with asbestos disease and its control in Great Britain's naval dockyards — P.G. Harries (1976)

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