Issues and controversies in the plain-film diagnosis of asbestos-related disorders in the chest.

This article reviews the chest radiographic manifestations of asbestos exposure. While the chest radiograph (CXR) is a highly valuable tool in the evaluation of asbestos-related disease, there are ongoing controversies regarding the sensitivity and specificity of the plain film in diagnosing asbestos-related disorders. Autopsy series indicate that at least 60% of pleural plaques may be overlooked. Conversely, such series indicate that up to 20% of plaques are falsely diagnosed. The significance of visceral pleural thickening and the definition and positive predictive value of diffuse pleural thickening as they relate to asbestos exposure are unresolved issues. Data suggest that the CXR may fail to reflect significant asbestosis in 10% to 20% of cases. On the other hand, the presence of overlying pleural abnormalities as well as technical factors may contribute to overreading of interstitial disease. Data on the rate of false positive readings for asbestosis are limited. Considered alone, the CXR can support but not specifically establish nor exclude the diagnosis of asbestosis. In practice, an ILO grade of less than 1/0 implies that the diagnosis is unlikely. A constellation of positive CXR findings may increase specificity, although the diagnosis rests on a combination of multiple clinical criteria.