Abstract
BackgroundIn patients with diffuse lung diseases, differentiating occupational lung diseases from other diseases is clinically important. However, the value of assessing asbestos and particles in bronchoalveolar lavage fluid (BALF) in diffuse lung diseases by electron microscopy (EM) remains unclear. We evaluated the utility of EM in detecting asbestos fibers and particles in patients with diffuse lung diseases.MethodsThe BALF specimens of 107 patients with diffuse lung diseases were evaluated. First, detection of asbestos by EM and light microscopy (LM) were compared. Second, the detection of asbestos using surgically obtained lung tissues of 8 of 107 patients were compared with the results of EM and LM in BALF. Third, we compared the results of mineralogical components of particles in patients with (n = 48) and without (n = 59) a history of occupational exposure to inorganic dust.ResultsBALF asbestos were detected in 11 of 48 patients with a history of occupational exposure by EM; whereas asbestos as asbestos bodies (ABs) were detected in BALF in 4 of these 11 patients by LM. Eight of 107 patients in whom lung tissue samples were surgically obtained, EM detected BALF asbestos at a level of >1,000 fibers/ml in all three patients who had ABs in lung tissue samples by LM at a level of >1,000 fibers/g. The BALF asbestos concentration by EM and in lung tissue by LM were positively correlated. The particle fractions of iron and phosphorus were increased in patients with a history of occupational exposure and both correlated with a history of occupational exposure by a multiple regression analysis.ConclusionsEM using BALF seemed to be superior to LM using BALF and displayed a similar sensitivity to LM using surgically-obtained lung tissue samples in the detection of asbestos. Our results also suggest that detection of elements, such as iron and phosphorus in particles, is useful for evaluating occupational exposure. We conclude that the detection of asbestos and iron and phosphorus in particles in BALF by EM is very useful for the evaluation of occupational exposure.
Highlights
In patients with diffuse lung diseases, differentiating occupational lung diseases from other diseases is clinically important
electron microscopy (EM) detected bronchoalveolar lavage fluid (BALF) uncoated asbestos fibers and ABs (AFs) at a level of >1,000 fibers/ml in all three patients who had asbestos bodies (ABs) in lung tissue samples by light microscopy (LM) at a level of >1,000 fibers/g. These results suggest that using BALF, EM was superior to LM to detect AFs, and the sensitivity of EM in detecting AFs in BALF was similar to that of LM using surgicallyobtained lung tissue samples
These results suggest that analysis including counting AFs and particles and evaluating their elements of BALF by EM is very useful for evaluating occupational exposure
Summary
In patients with diffuse lung diseases, differentiating occupational lung diseases from other diseases is clinically important. We evaluated the utility of EM in detecting asbestos fibers and particles in patients with diffuse lung diseases. Differentiating occupational lung diseases including asbestosis from other diffuse lung diseases, such as idiopathic pulmonary fibrosis (IPF), is important in patients with diffuse lung diseases, for diagnostic and treatment and for legal, ecological and social reasons [1]. The detection of asbestos bodies (ABs) in bronchoalveolar lavage fluid (BALF) by light microscopy (LM) is useful for diagnosing asbestos-related lung diseases, but is sometimes undetectable, even in patients with heavy asbestos exposure [2,3,4,5,6,7]. We investigated the diagnostic utility of detecting AFs and the mineralogical elements in BALF by EM in patients with diffuse lung diseases
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call