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Screening of miners and millers at decreasing levels of asbestos exposure: comparison of chest radiography and thin-section computed tomography.

Terra-Filho M, Bagatin E, Nery LE, Nápolis LM, Neder JA, de Souza Portes Meirelles G, Silva CI, Muller NL - PLoS ONE (2015)

Bottom Line: It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases.CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure.Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary Division, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

ABSTRACT

Background: Chest radiography (CXR) is inferior to Thin-section computed tomography in the detection of asbestos related interstitial and pleural abnormalities. It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases.

Methods: Clinical evaluation, CXR, Thin-section CT and spirometry were obtained in 1418 miners and millers who were exposed to progressively lower airborne concentrations of asbestos. They were separated into four groups according to the type, period and measurements of exposure and/or procedures for controlling exposure: Group I (1940-1966/tremolite and chrysotile, without measurements of exposure and procedures for controlling exposure); Group II (1967-1976/chrysotile only, without measurements of exposure and procedures for controlling exposure); Group III (1977-1980/chrysotile only, initiated measurements of exposure and procedures for controlling exposure) and Group IV (after 1981/chrysotile only, implemented measurements of exposure and a comprehensive procedures for controlling exposure).

Results: In all groups, CXR suggested more frequently interstitial abnormalities and less frequently pleural plaques than observed on Thin-section CT (p<0.050). The odds for asbestosis in groups of decreasing exposure diminished to greater extent at Thin-section CT than on CXR. Lung function was reduced in subjects who had pleural plaques evident only on Thin-section CT (p<0.050). In a longitudinal evaluation of 301 subjects without interstitial and pleural abnormalities on CXR and Thin-section CT in a previous evaluation, only Thin-section CT indicated that these ARA reduced as exposure decreased.

Conclusions: CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure. Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.

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Incidence rates of asbestosis and pleural plaques in groups of decreasing levels of asbestos exposure.Note that the marked reduction in incidence of both asbestosis and pleural plaques from Groups I to IV detected by Thin-section CT (TSCT) was not found in the CXR analysis.
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pone.0118585.g001: Incidence rates of asbestosis and pleural plaques in groups of decreasing levels of asbestos exposure.Note that the marked reduction in incidence of both asbestosis and pleural plaques from Groups I to IV detected by Thin-section CT (TSCT) was not found in the CXR analysis.

Mentions: At follow-up, 11 individuals had pulmonary findings consistent with asbestosis on Thin-section CT (overall incidence rate of 1.09 cases of asbestosis per 100,000 person-years). All cases were distributed between groups I (n = 3) and II (n = 8). Eighteen individuals developed pleural plaques evident on Thin-section CT distributed over groups I (n = 5), II (n = 10), and III (n = 3). The overall incidence rate was 1.75 cases of pleural plaques per 100,000 person-years during this time period. When using CXR as the diagnostic method, the overall incidence rate for asbestosis was 1.99 cases per 100,000 person-years (total 20 cases of asbestosis diagnosed by CXR). Cases were distributed across groups I (n = 1), II (n = 12), III (n = 6), and IV (n = 1). There was only 1 case of pleural plaque diagnosed by CXR in group II (incidence rate of 0.20 cases of pleural plaques per 100,000 person-years). There were no incident cases of pleural disease in Group I, III and IV. (Fig. 1) Considering Thin-section CT as the diagnostic method, the incidence rate ratio (IRR) and 95% CI for asbestosis in group II, using group I as reference was 0.24 (0.06–0.90). For pleural plaques, using group I as reference, the IRR for group II was 0.20 (0.07–0.60) and for group III was 0.08 (0.02–0.36). Using CXR as diagnostic method and group I as reference, the IRR for asbestosis in groups II, III and IV were: 1.08 (0.14–8.36); 0.76 (0.09–6.33); and 0.84 (0.05–13.49).


Screening of miners and millers at decreasing levels of asbestos exposure: comparison of chest radiography and thin-section computed tomography.

Terra-Filho M, Bagatin E, Nery LE, Nápolis LM, Neder JA, de Souza Portes Meirelles G, Silva CI, Muller NL - PLoS ONE (2015)

Incidence rates of asbestosis and pleural plaques in groups of decreasing levels of asbestos exposure.Note that the marked reduction in incidence of both asbestosis and pleural plaques from Groups I to IV detected by Thin-section CT (TSCT) was not found in the CXR analysis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4366170&req=5

pone.0118585.g001: Incidence rates of asbestosis and pleural plaques in groups of decreasing levels of asbestos exposure.Note that the marked reduction in incidence of both asbestosis and pleural plaques from Groups I to IV detected by Thin-section CT (TSCT) was not found in the CXR analysis.
Mentions: At follow-up, 11 individuals had pulmonary findings consistent with asbestosis on Thin-section CT (overall incidence rate of 1.09 cases of asbestosis per 100,000 person-years). All cases were distributed between groups I (n = 3) and II (n = 8). Eighteen individuals developed pleural plaques evident on Thin-section CT distributed over groups I (n = 5), II (n = 10), and III (n = 3). The overall incidence rate was 1.75 cases of pleural plaques per 100,000 person-years during this time period. When using CXR as the diagnostic method, the overall incidence rate for asbestosis was 1.99 cases per 100,000 person-years (total 20 cases of asbestosis diagnosed by CXR). Cases were distributed across groups I (n = 1), II (n = 12), III (n = 6), and IV (n = 1). There was only 1 case of pleural plaque diagnosed by CXR in group II (incidence rate of 0.20 cases of pleural plaques per 100,000 person-years). There were no incident cases of pleural disease in Group I, III and IV. (Fig. 1) Considering Thin-section CT as the diagnostic method, the incidence rate ratio (IRR) and 95% CI for asbestosis in group II, using group I as reference was 0.24 (0.06–0.90). For pleural plaques, using group I as reference, the IRR for group II was 0.20 (0.07–0.60) and for group III was 0.08 (0.02–0.36). Using CXR as diagnostic method and group I as reference, the IRR for asbestosis in groups II, III and IV were: 1.08 (0.14–8.36); 0.76 (0.09–6.33); and 0.84 (0.05–13.49).

Bottom Line: It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases.CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure.Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary Division, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

ABSTRACT

Background: Chest radiography (CXR) is inferior to Thin-section computed tomography in the detection of asbestos related interstitial and pleural abnormalities. It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases.

Methods: Clinical evaluation, CXR, Thin-section CT and spirometry were obtained in 1418 miners and millers who were exposed to progressively lower airborne concentrations of asbestos. They were separated into four groups according to the type, period and measurements of exposure and/or procedures for controlling exposure: Group I (1940-1966/tremolite and chrysotile, without measurements of exposure and procedures for controlling exposure); Group II (1967-1976/chrysotile only, without measurements of exposure and procedures for controlling exposure); Group III (1977-1980/chrysotile only, initiated measurements of exposure and procedures for controlling exposure) and Group IV (after 1981/chrysotile only, implemented measurements of exposure and a comprehensive procedures for controlling exposure).

Results: In all groups, CXR suggested more frequently interstitial abnormalities and less frequently pleural plaques than observed on Thin-section CT (p<0.050). The odds for asbestosis in groups of decreasing exposure diminished to greater extent at Thin-section CT than on CXR. Lung function was reduced in subjects who had pleural plaques evident only on Thin-section CT (p<0.050). In a longitudinal evaluation of 301 subjects without interstitial and pleural abnormalities on CXR and Thin-section CT in a previous evaluation, only Thin-section CT indicated that these ARA reduced as exposure decreased.

Conclusions: CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure. Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.

Show MeSH
Related in: MedlinePlus