Issues and controversies in the plain-film diagnosis of asbestos-related disorders in the chest

Our plain-English summary of Issues and controversies in the plain-film diagnosis of asbestos-related disorders in the chest, by W.B. Gefter, E.F. Conant (Journal of Thoracic Imaging, 1988).

The study

• Authors: W.B. Gefter, E.F. Conant
• Journal: Journal of Thoracic Imaging
• Published: 1988;3(4):11-28
• Type of article: Review
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000907).

Abstract

This article reviews the chest radiographic manifestations of asbestos exposure. While the chest radiograph (CXR) is a highly valuable tool in the evaluation of asbestos-related disease, there are ongoing controversies regarding the sensitivity and specificity of the plain film in diagnosing asbestos-related disorders. Autopsy series indicate that at least 60% of pleural plaques may be overlooked. Conversely, such series indicate that up to 20% of plaques are falsely diagnosed. The significance of visceral pleural thickening and the definition and positive predictive value of diffuse pleural thickening as they relate to asbestos exposure are unresolved issues. Data suggest that the CXR may fail to reflect significant asbestosis in 10% to 20% of cases. On the other hand, the presence of overlying pleural abnormalities as well as technical factors may contribute to overreading of interstitial disease. Data on the rate of false positive readings for asbestosis are limited. Considered alone, the CXR can support but not specifically establish nor exclude the diagnosis of asbestosis. In practice, an ILO grade of less than 1/0 implies that the diagnosis is unlikely. A constellation of positive CXR findings may increase specificity, although the diagnosis rests on a combination of multiple clinical criteria.

In plain English

This article was a review of published research on how asbestos-related chest disorders appear on plain chest X-rays and how reliably X-rays detect them. It covered pleural plaques, diffuse pleural thickening and asbestosis (lung scarring), among other findings. The authors reported that autopsy series indicated at least 60% of pleural plaques may be overlooked on X-ray and up to 20% may be falsely diagnosed. In one autopsy study the authors reviewed, strict criteria found plaques on X-ray in 3 (12.5%) of 24 men with autopsy-proven plaques, with no false positives. Looser criteria found 11 (46%) but gave 15 (58%) false-positive X-rays. The authors stated that data suggested X-rays may miss significant asbestosis in 10% to 20% of cases. They also stated that overlying pleural changes and technical factors may cause overreading, and that data on false-positive asbestosis readings were limited. They described the meaning of diffuse pleural thickening as unresolved. The authors concluded that the X-ray alone can support but not establish or exclude asbestosis, and that an ILO grade below 1/0 implies the diagnosis is unlikely.

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: Review of published literature on the plain chest radiograph in asbestos-related disorders
• Who was studied: No study population of its own. The authors reviewed published autopsy series, radiographic surveys and CT studies.
• Exposure: Asbestos exposure in general (no single fiber type or job studied). The review covered radiographic detection of pleural plaques, diffuse pleural thickening and interstitial disease (asbestosis).
• Main results:
  • From the autopsy series reviewed, at least 60% of pleural plaques may be overlooked on the chest radiograph.
  • From the autopsy series reviewed, up to 20% of plaques are falsely diagnosed on the radiograph.
  • In the Hillerdal and Lindgren autopsy study reviewed, 24 men with autopsy-proven plaques had chest radiographs. Using strict criteria, only 3 (12.5%) had radiographically detectable plaques, with no false-positive diagnoses.
  • In the same study, liberalized criteria detected 11 (46%) of the 24 cases, but there were also 15 (58%) false-positive chest radiographs.
  • The authors stated that data suggest the chest radiograph may fail to reflect significant asbestosis in 10% to 20% of cases.
  • The authors stated that overlying pleural abnormalities and technical factors may contribute to overreading of interstitial disease, and that data on false-positive readings for asbestosis are limited.
  • The authors described the definition and positive predictive value of diffuse pleural thickening, in relation to asbestos exposure, as unresolved issues.
• The authors' conclusion: The authors concluded that, considered alone, the chest radiograph can support but not specifically establish or exclude a diagnosis of asbestosis. In practice, an ILO grade of less than 1/0 implies the diagnosis is unlikely. A combination of positive findings may increase specificity, but the diagnosis rests on multiple clinical criteria.
• Limitations the authors state:
  • The authors stated that their intent was to highlight the controversies rather than to resolve them.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Chest X-Ray, Autopsy, Pleural Plaques, Pleural Thickening, Diffuse Pleural Thickening, Interstitial.

Related studies

• Asbestos-related chest diseases: plain radiographic findings — W.T. Miller, W.B. Gefter, et al. (1992)
• Increased body mass index is related to apparent circumscribed pleural thickening on plain chest radiographs — Y.C. Lee, C.K. Runnion, et al. (2001)
• Relationship between number of asbestos bodies in autopsy lung and pleural plaques on chest X-ray film — T. Kishimoto, T. Ono, et al. (1989)
• Thoracic surgical problems in asbestos-related disorders — E.A. Gaensler, T.C. McLoud, et al. (1985)
• Assessment of physicians' proficiency in reading chest radiographs for pneumoconiosis, based on a 60-film examination set with two factors constituting eight indices — T. Tamura, Y. Kusaka, et al. (2018)
• Surgical treatment of asbestos-related disease of the chest — L.P. Faber (1988)

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