Radiologic and surgical aspects of the diaphragm in asbestos exposure

Our plain-English summary of Radiologic and surgical aspects of the diaphragm in asbestos exposure, by L. Di Menza, A. Hirsch, M. Mangold, et al (Annals of the New York Academy of Sciences, 1979).

The study

• Authors: L. Di Menza, A. Hirsch, M. Mangold, J. Bignon
• Journal: Annals of the New York Academy of Sciences
• Published: 1979;330:787-9
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003992).

In plain English

This short workshop report from a hospital in Créteil, France, compared a chest X-ray sign with what surgeons saw during chest operations. The sign was straightness of the diaphragm, meaning its middle third looked straight instead of curved. The authors studied 47 consecutive thoracotomies: 37 for lung carcinoma and 10 for other causes, excluding mesothelioma. Asbestos exposure was assessed with an occupational questionnaire, and fiber types were not given. Diaphragmatic straightness was seen on X-rays in 14 patients (30 percent). Surgeons found parietal pleural plaques in 18 patients (38 percent). On the operated side, X-rays agreed with surgery in 80 percent of cases. Of 10 patients with diaphragmatic plaques at surgery, 4 showed no straightness. Of 11 with straightness, 5 had no plaques. The authors reported that the 37 exposed patients differed significantly from the 10 unexposed in X-ray appearance, but not in surgical plaques (17 of 37 versus 1 of 10). They noted that the unexposed patients were younger. The authors concluded that whether straightness is an early or sensitive sign of asbestos exposure remains an open question.

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: Hospital case series comparing pre-operative chest X-ray findings with surgical findings at thoracotomy (short workshop report)
• Who was studied: 47 consecutive patients who had thoracotomies (37 for lung carcinoma, 10 for other causes, mesothelioma excluded), at hospitals in Créteil, France; 37 classed as asbestos exposed and 10 as unexposed; study dates not given
• Exposure: Possible occupational asbestos exposure, identified by a standardized occupational history questionnaire; fiber types, products and doses not given
• Main results:
  • Diaphragmatic straightness (unilateral or bilateral) was seen on both lateral and frontal X-rays in 30 percent of the 47 patients (14 cases, 11 on the operated side)
  • At thoracotomy, surgeons found parietal pleural plaques in 38 percent of the 47 patients (18 cases: diaphragmatic and costal in 9, diaphragmatic only in 1, costal only in 8)
  • X-ray readings agreed with surgical findings in 80 percent of the 47 cases (6 positive and 32 negative on both)
  • False negatives: 4 of the 10 patients with diaphragmatic plaques at surgery showed no diaphragmatic straightness on X-ray
  • False positives: of the 11 cases of straightness on the operated side, 5 had no plaque seen at surgery
  • Normal chest X-rays: 16 of 37 exposed patients (43%) versus 9 of 10 unexposed patients (90%), printed P 0.08. The authors described the difference in X-ray appearance between the groups as significant.
  • Diaphragmatic rigidity: 14 of 37 exposed patients (38%) versus 0 of 10 unexposed patients (0%), printed P 0.06
  • Diaphragm and/or parietal plaques at surgery: 17 of 37 exposed patients (46%) versus 1 of 10 unexposed patients (10%), printed P 0.09. The authors described this difference as insignificant.
• The authors' conclusion: The authors concluded that whether diaphragmatic straightness is an early and/or sensitive index of asbestos exposure remains an open question. They said further research is needed on the sign's specificity, sensitivity and fidelity before it could be considered for the ILO/UC classification of pneumoconiosis.
• Limitations the authors state:
  • The exposed and unexposed groups were not comparable in age: unexposed patients averaged 51 years and exposed patients 59 years
  • The mismatches between X-ray and surgery show the limits of both radiologic and surgical techniques for detecting pleural abnormalities
  • Looking at the diaphragm during surgery does not allow its normality to be judged accurately

Topics

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

Medical terms in this study, explained in our Lexicon: Diaphragm, Asbestos Exposure.

Related studies

• Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery — T. Tokunaga, N. Sawabata, et al. (2010)
• Effect of asbestos-related pleural fibrosis on excursion of the lower chest wall and diaphragm — B. Singh, P.R. Eastwood, et al. (1999)
• The management of the diaphragm during radical surgery for malignant pleural mesothelioma — A.J. Sharkey, R. Bilancia, et al. (2016)
• Long-term Survival and Propensity Score Matched Outcomes of Bilateral vs. Unilateral Diaphragm Interventions in Cytoreductive Surgery plus Intra-peritoneal Chemotherapy — B. Singh, G. Singh, et al. (2018)
• Diaphragm reconstruction by GORE DUALMESH in patients undergoing resection for thoracic malignancies — A. Sano, Y. Azuma, et al. (2021)
• Surgical and pathologic aspects of asbestosis — W.F. Sasser, W.A. Bari (1981)

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