TruCutR needle biopsy in asbestosis and silicosis: correlation of histological changes with radiographic changes and pulmonary function in 41 patients

Our plain-English summary of TruCutR needle biopsy in asbestosis and silicosis: correlation of histological changes with radiographic changes and pulmonary function in 41 patients, by P. Tukiainen, E. Taskinen, O. Korhola, et al (British Journal of Industrial Medicine, 1978).

The study

• Authors: P. Tukiainen, E. Taskinen, O. Korhola, M. Valle
• Journal: British Journal of Industrial Medicine
• Published: 1978;35(4):292-304
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy.

Abstract

A percutaneous needle biopsy was performed with a TruCut needle on 41 patients with suspected pneumoconiosis. Patients selected for biopsy tended to have brief or unusual dust exposure, as well as questionable radiographic opacities. Sixteen had been exposed to asbestos, 13 to silica and 12 to mixed dust containing quartz, coal, iron, asbestos and talc. All patients in the asbestos group and most in the other two groups had a reduced transfer factor. Most patients in the asbestos group and about 25% of the other patients had restrictive ventilatory impairment. Chest radiographs were assessed according to standard films of the ILO U/C International Classification (International Labour Office, 1972). In 25 patients radiographic opacities were absent or acanty (categories 0--1/1). The dominant radiographic feature of many patients exposed to asbestos was a ground-glass appearance or a bilateral elevation of the diaphragm, or both, features difficult to assess according to the ILO U/C scheme. Most histological changes were those usually seen in pneumoconiosis. However, in only two patients with silicosis were silicotic nodules detected. The specimens of seven patients showed a granulomatous inflammation. The severity of alveolar wall involvement correlated well with the transfer factor value but poorly with radiographic changes. The profusion of radiographic opacities also correlated poorly with functional impairment. As a diagnostic tool the needle biopsy was valuable in asbestosis and slightly less so in mixed-dust fibrosis. The biopsy specimens showed changes compatible with asbestosis in 75% of the suspected cases and in 86% of those in which asbestosis was the final diagnosis. In the mixed-dust group pneumoconiosis was confirmed in 67% and 80%, respectively. In the diagnosis of silicosis an open biopsy is probably more reliable than a percutaneous one, particularly if radiographic changes are minimal. Histological changes in the needle biopsy specimen were compatible with silicosis in only 36% of the suspected cases and in 63% of those in which the final diagnosis was silicosis.

In plain English

This Helsinki study described 41 patients (38 men, 3 women) with suspected pneumoconiosis who underwent TruCut needle lung biopsy; two biopsies yielded no lung tissue. Sixteen had been exposed mainly to asbestos, 13 mainly to quartz (silica) and 12 to mixed dust containing quartz, coal, iron, asbestos and talc. All 16 in the asbestos group had a reduced transfer factor, a measure of gas exchange, and 11 of them had mild or no X-ray opacities. Of the 14 patients finally diagnosed with asbestosis, the biopsy gave valuable diagnostic information in 12 (86%). The figure was 8 of 10 (80%) for mixed-dust pneumoconiosis and 5 of 8 (63%) for silicosis. Moderate or marked thickening of the alveolar walls went with a significantly lower transfer factor, but X-ray opacities matched wall thickening and lung function poorly. The authors concluded that needle biopsy was a valuable tool in difficult cases of asbestosis with mild or absent X-ray changes. They preferred open biopsy for suspected silicosis. They cautioned that dust particles, even asbestos bodies, do not prove that the dust caused the disease.

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: Clinical case series evaluating percutaneous TruCut needle lung biopsy as a diagnostic tool in suspected pneumoconiosis, with comparison of tissue findings to lung function and chest radiographs
• Who was studied: 41 patients (3 women, 38 men), aged 34 to 71 years (mean 51), with undiagnosed diffuse lung disease suspected of being pneumoconiosis. They were selected from a needle biopsy series of over 350 patients with diffuse lung diseases at hospitals and the Institute of Occupational Health in Helsinki, over the preceding five years.
• Exposure: Sixteen patients were exposed mainly to asbestos (fiber type not specified), 13 mainly to quartz, and 12 to mixed dust containing quartz, coal, iron, asbestos and talc. For 20 patients the adequacy of exposure was in doubt. Examples given were dismantling old lagging, insulation work with asbestos-cement products, and packing rubber balls (talc). In the asbestos group the mean exposure duration was 13 years, and the interval from first exposure to biopsy was 8 to 34 years (mean 22).
• Main results:
  • Of the 41 biopsies, the specimen was large in 13, medium in 14, small in 11 and inadequate in one; two biopsies yielded no lung tissue.
  • Transfer factor was lowered in all 16 patients in the asbestos group (DLCO mean 55% of predicted, range 22 to 75%).
  • In 25 of the 41 subjects, including 11 of the 16 in the asbestos group, radiographic opacities were mild or lacking (ILO categories 0 to 1/1).
  • Among asbestos-exposed patients, eight had bilateral elevation of the diaphragm and four had a ground-glass appearance. The authors describe both features as difficult to categorise with the ILO U/C 1971 scheme.
  • In two asbestos-exposed patients, local infiltrates were later found to be due to bronchial carcinoma.
  • In the asbestos group, the needle biopsy provided valuable information in 12 of the 14 patients whose final diagnosis was asbestosis (86%).
  • Biopsy changes were compatible with asbestosis in 75% of suspected cases and 86% of final asbestosis cases. For mixed dust the figures were 67% and 80%; for silicosis, 36% of suspected cases and 63% of final cases.
  • Mixed-dust group: the biopsy confirmed the diagnosis in 8 of the 10 patients whose final diagnosis was pneumoconiosis (80%).
  • Silica group: the needle biopsy provided diagnostic information in 5 of the 8 patients whose final diagnosis was silicosis (63%). Typical silicotic nodules were found in only two patients.
  • Asbestosis was diagnosed from biopsy findings in three patients exposed for seven months to three years, 12 to 30 years before the biopsy.
  • Seven patients had a granulomatous reaction in their specimens that was difficult to distinguish from that seen in sarcoidosis.
  • Across all patients, mean gas transfer factor was significantly lower (p less than 0.01) when the alveolar walls were moderately or markedly thickened than when they were normal or slightly thickened.
  • The profusion of radiographic opacities correlated poorly with the degree of alveolar wall thickening.
  • Radiographic appearance correlated with gas transfer factor in the asbestos group (p less than 0.05) but not in the silicosis group, with striking individual exceptions.
  • Vital capacity was significantly lower in patients with pleural thickening of any kind than in those without it.
  • The authors reported no serious complications in more than 350 needle lung biopsies for diffuse lung disease.
• The authors' conclusion: The authors concluded that, despite the small specimen, needle biopsy is a valuable diagnostic tool in troublesome cases of asbestosis in which radiographic changes are mild or lacking.
• Limitations the authors state:
  • Finding dust particles, even asbestos bodies, in lung tissue does not prove that the dust caused the disease.
  • In silicosis a needle biopsy is often unrepresentative. Nodules are unevenly distributed and more prominent in the upper lobes, the needle is narrow, and all biopsies came from the right lower lobe. The authors therefore preferred open biopsy, especially when X-ray changes are slight.
  • Biopsies were always taken from the lower lobe, although the lower lobes are not always the most affected part of the lungs.
  • In the four asbestosis patients with granulomata, no Kveim tests or extrapulmonary biopsies were done to exclude sarcoidosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Needle Biopsy, Silicosis, Pneumoconiosis, Biopsy, Talc, Chest X-Ray, Bilateral, Diaphragm.

Related studies

• Radiographic evidence of silicosis risk in the diatomaceous earth industry — J.M. Hughes, H. Weill, et al. (1998)
• Radiographic changes and lung function in relation to activity of the glutathione transferases theta and mu among asbestos cement workers — K. Jakobsson, A. Rannug, et al. (1995)
• Pulmonary ventilatory function in talcosis of lung — M. Kleinfeld, J. Messite, et al. (1964)
• Lung function in relation to radiographic changes in asbestos workers — S. Zedda, G. Aresini, et al. (1973)
• Lung function and radiographic change in chrysotile workers in Swaziland — M. McDermott, M.M. Bevan, et al. (1982)
• Asbestosis and silicosis — G.R. Wagner (1997)

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