Histopathology. 2016 Feb;68(3):339-46. doi: 10.1111/his.12751.

Asbestos exposure increases the incidence of histologically confirmed usual interstitial pneumonia.

 

Kawabata Y1, Shimizu Y1, Hoshi E2, Murai K2, Kanauchi T3, Kurashima K4, Sugita Y4.
  • 1Division of Diagnostic Pathology, Saitama Prefectural Cardiovascular and Respiratory Centre, Kumagaya city, Japan.
  • 2Department of Thoracic Surgery, Saitama Prefectural Cardiovascular and Respiratory Centre, Kumagaya city, Japan.
  • 3Department of Radiology, Saitama Prefectural Cardiovascular and Respiratory Centre, Kumagaya city, Japan.
  • 4Department of Pulmonary Medicine, Saitama Prefectural Cardiovascular and Respiratory Centre, Kumagaya city, Japan.

 

Abstract

AIMS: We hypothesized that asbestos exposure increases the incidence of macroscopically visible and histologically confirmed usual interstitial pneumonia (histological UIP).

METHODS AND RESULTS: We retrospectively examined 1718 cases (1202 males; mean age 66.7 years) who underwent lobectomy for resection of pleuropulmonary tumours. Objective markers for asbestos exposure included: the presence of malignant pleural mesothelioma, the presence of pleural plaques (PPs) and asbestos bodies in the histological specimen. Risk factors for histological UIP were examined. Two separate groups were studied: 183 with asbestos exposure, and 239 with histological UIP. The 183 cases with asbestos exposure had higher rates of positive occupational history and histological UIP (31%) than the remaining 1535. Among the asbestos-exposed group, small numbers of asbestos bodies were found in histological specimens of 21 cases of histological UIP. PPs and asbestos bodies were more frequent in the 239 patients with histological UIP than in the remaining 1479 UIP-negative patients. Multivariate analysis showed that asbestos exposure, especially positivity for asbestos bodies, that does not meet the current criteria for asbestosis increases the risk of histological UIP (P < 0.0001).

CONCLUSIONS: Asbestos exposure causes asbestosis and increases the incidence of histological UIP.

KEYWORDS: asbestos exposure; malignant pleural mesothelioma; pleural plaque; usual interstitial pneumonia

PMID: 26046696

 

Supplement:

Asbestos exposure causes asbestosis, lung cancer, and malignant pleural mesothelioma (MPM).

It currently remains unknown whether exposure to a mild to moderate amount of asbestos causes pulmonary fibrosis. Pathologically, idiopathic pulmonary fibrosis (IPF) is termed usual interstitial pneumonia (UIP) (1). Various causes or diseases result in UIP such as collagen vascular disease (CVD), chronic hypersensitivity pneumonia (CHP), and exposure to various types of dust (including silica and hard metal) (2). Histologically, CVD-related UIP and CHP differ slightly from IPF, and difficulties are associated with differentiating between them based on histological features (2).

We hypothesized that exposure to a mild to moderate amount of asbestos that does not cause asbestosis may increase the risk of histologically confirmed UIP.

We defined asbestos exposure as follows: individuals with the presence of less than 2 asbestos bodies/1 cm2 in histological specimens, b. the presence of MPM, or c. the presence of pleural plaques. We compared an asbestos exposure group and a non-exposure group using lobectomy for lung tumors. A multivariate analysis showed that asbestos exposure, particularly positivity for asbestos bodies, that does not meet the current criteria for asbestosis increases the risk of histological UIP (P < 0.0001).

We consider there to be asbestos-exposed UIP cases among IPF cases, particularly histological UIP with positivity for tissue asbestos bodies. The potential relationship between asbestos exposure and UIP is shown in Figure 1. We intend to examine the dose relationship between asbestos exposure and histological UIP in future studies.

 

fig1

References.

  1. American Thoracic Society/European Respiratory Society. International multidisciplinary consensus classification of the idiopathic interstitial pneumonia. Am. J. Respir. Crit. Care Med. 2002; 165; 277–304.
  2. Kawabata Y. Why Does the Pathological Classification of IIPs Vary Among Pathologists?, in idiopathic pulmonary fibrosis, eds. Hiroyuki Nakamura and Kazutetsu Aoshiba. Springer Japan 2016:105-132. DOI 10.1007/978-4-431-55582-7.

 

Yoshinori Kawabata, Division of Diagnostic Pathology,

Saitama Prefectural Cardiovascular and Respiratory Centre,

Itai 1696, Kumagaya City, Saitama 360-0105, Japan.

e-mail: kawabata.yoshinori@pref.saitama.lg.jp

 

 

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