Pulmonary fibrosis in asbestos insulation workers with lung cancer: a radiological and histopathological evaluation.

Abstract

This study was undertaken to determine the relation between radiographic and histological manifestations of pulmonary asbestosis (interstitial fibrosis) in insulation workers who had died of lung cancer. Of 450 confirmed deaths from lung cancer a chest radiograph suitable for determining evidence of pneumoconiosis was obtained in 219. Of these cases, 138 also had a tissue specimen submitted that was suitable for histological study to determine the extent of histological fibrosis. There was a significant albeit limited correlation between the radiographic and histological findings (r = 0 27, p < 0-0013). All 138 cases had histological evidence of parenchymal fibrosis; in 25 (18%), however, there was no radiographic evidence of parenchymal fibrosis. In 10 cases (7%) both parenchymal and pleural disease were undetectable on the radiograph. Thus a negative chest radiograph does not exclude the presence of interstitial fibrosis (asbestosis) in a substantial proportion of insulation workers previously exposed to asbestos who develop lung cancer.

Asbestos, asbestosis, pleural plaques and lung cancer

“…Unfortunately, the agreement between readers (or even the same reader at 2 different times) at this level is often not very good. The specificity and the sensitivity when compared with autopsy findings is also poor, and false negative and false positive results are very common (87)(88)(89). A confounding factor is smoking, which can cause a significantly higher incidence of small issegular opacities in chest roentgenograms (90,91).…”

“…As proof of the "asbestosis-cancer hypothesis" some studies have been cited in which all patients with lung cancer also had asbestosis to some degree at autopsy. For instance, Kipen et a1 (1987) published 138 cases of lung cancer among asbestos insulation workers who all had asbestosis at autopsy; 18% of the asbestosis cases were not diagnosed from X-ray appearances (87).…”

The Pneumoconioses

“…In patients with asbestosis, the chest radiograph usually shows small bilateral parenchymal opacities with a multinodular or reticular pattern that may be associated with pleural abnormalities. However, in some individuals with histopathologic evidence of pulmonary fibrosis, no interstitial abnormalities are found on the chest radiographs (Larson et al, 2010; Kipen et al, 1987). Other asbestos-related disorders are: pleural plaques, mesothelioma, diffuse pleural fibrosis, rounded atelectasia, benign asbestos-related pleural effusion and chronic bronchitis.…”

In-vitro toxicology of respirable iron-rich particles relevant to mining industry: a high throughput framework for interpreting environmental particulate matter toxicity

“…Symptoms may take up to 40 years to develop after the initial exposure, although in up to a fifth of patients abnormalities such as diffuse interstitial pulmonary fibrosis may not appear on X-ray 129,130 .…”

“…While the exact mechanism of toxicity is debated, inhalation of amphibole asbestos and very high concentrations of serpentine asbestos is associated with diffuse interstitial pulmonary fibrosis, the formation of asbestos bodies, pleural inflammation, lung cancer and mesotheliomas [126][127][128][129] . Symptoms may take up to 40 years to develop after the initial exposure, although in up to a fifth of patients abnormalities such as diffuse interstitial pulmonary fibrosis may not appear on X-ray 129,130 .…”