title: Factors associated with early-stage pulmonary fibrosis as determined by high-resolution computed tomography among persons occupationally exposed to asbestos.
abstract: OBJECTIVE
  Asbestosis remains difficult to diagnose, particularly in its early stages. The aim of this study was to determine criteria for independently associated features of pulmonary fibrosis in high-resolution computed tomograms among persons occupationally exposed to asbestos.
  
  
  METHODS
  Retired persons with documented occupational asbestos exposure and no known asbestos-related diseases were assessed for occupational, clinical, functional respiratory, and chest X-ray criteria. In addition, they all underwent high-resolution computed tomography (HRCT) in the prone position.
  
  
  RESULTS
  Altogether 51 (7.2%) of the 706 enrolled participants had features of pulmonary fibrosis consistent with asbestosis in the HRCT. Among those with small irregular opacities of <1/0 according to the 1980 International Labour Office Classification (ILO-C) in their X-rays, 5% had asbestosis in the HRCT. In a multivariate analysis, only age [odds ratio (OR) per year 1.08, 95% confidence interval (95% CI) 1.02-1.14], cumulative-exposure index (CEI) for asbestos (OR 6.4, 95% CI 1.5-28.4 for a CEI of > or =100 fibers/ml x years), and the presence of small irregular X-ray opacities of > or =1/0 ILO-C (OR 3.0, 95% CI 1.6-6.0) were independently associated with HRCT asbestosis. No combinations of these criteria simultaneously yielded high sensitivity and specificity for the diagnosis of early-stage HRCT asbestosis. Moreover, only 2% of the persons with a CEI of <25 fibers/ml x years had HRCT asbestosis, the finding confirming the low incidence of asbestosis for such low exposure, as previously reported on the basis of X-ray data.
  
  
  CONCLUSIONS
  Additional research is needed to better identify the persons most likely to benefit from HRCT screening for asbestosis.
authors.affiliation: Occupational Diseases Department, Nancy University Hospital, Nancy, France. c.paris@chu-nancy.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Paris
authors.forename: Jacques
authors.initials: J
authors.lastname: Benichou
authors.forename: Claude
authors.initials: C
authors.lastname: Raffaelli
authors.forename: Anne
authors.initials: A
authors.lastname: Genevois
authors.forename: Luc
authors.initials: L
authors.lastname: Fournier
authors.forename: Geraldine
authors.initials: G
authors.lastname: Menard
authors.forename: Nathalie
authors.initials: N
authors.lastname: Broessel
authors.forename: Jacques
authors.initials: J
authors.lastname: Ameille
authors.forename: Patrick
authors.initials: P
authors.lastname: Brochard
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Gillon
authors.forename: Antoine
authors.initials: A
authors.lastname: Gislard
authors.forename: Marc
authors.initials: M
authors.lastname: Letourneux
mesh_terms: D000368:Aged; D001194:Asbestos / Q000633:toxicity; D001195:Asbestosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D010808:Physical Examination; D010991:Plethysmography; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D012179:Retirement; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014109:Total Lung Capacity / Q000502:physiology
chemical_list: D001194:Asbestos