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Radiographic and pathologic correlation of coal workers' pneumoconiosis.

Vallyathan-V; Brower-PS; Green-FH; Atfield-MD
Am J Respir Crit Care Med 1996 Sep; 154(3):741-748
The relationship between postmortem pathological abnormalities and changes in chest radiographs (CXR) was studied in 430 autopsied coal miners. At autopsy, lung sections were reviewed and graded for severity. Three or more CXR, most taken within 3 years before death, were available for each miner. On average, miners had about 34 years exposure to coal mining, and the average year of death was 68. Pathology profiles showed the percent frequency distribution for macules (96%), micronodules (70%), macronodules (45%), and progressive massive fibrosis (PMF) (28%). The relationship between profusion category of small opacities on CXR and severity of pathological lesions was examined by logistic regression. For category 0/1, all estimated parameters were positive, indicating that the odds that a positive CXR will be found increased when any abnormality was present in terms of pathological findings. The strongest effects were seen for micronodules and macronodules. The odds ratio (OR) that a category 0/1 CXR would be reported for mild and moderate/severe grades of micronodules compared with normal grade were 3.3 and 11.4, respectively. Examination of types of small opacities showed that rounded opacities predominated (63%), followed by irregular types (16%) and mixed types (12%). There was 83% agreement on the presence versus absence of PMF and large opacities, and significant overall correlation between the size of large opacities on CXR and grading of PMF in whole lung slices. The authors conclude that chest radiography is limited in the diagnosis of coal miners pneumoconiosis and PMF, specifically because of the insensitivity of CXR to detect milder grades of coal miners pneumoconiosis.
NIOSH-Author; Coal-mining; Coal-workers; Chest-X-rays; Radiodiagnosis; Respiratory-system-disorders; Coal-workers-pneumoconiosis; Postmortem-examination; Humans
Val Vallyathan, Ph.D., NIOSH Pathology Section, 1095 Willowdale Road, MS 211, Morgantown, WV 26505
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American Journal of Respiratory and Critical Care Medicine