Radiographic and pathologic correlation of coal workers' pneumoconiosis
Radiographic and pathologic correlation of coal workers' pneumoconiosis
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DOI：
10.1164/ajrccm.154.3.8810614
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发表时间：
1996-09-01
影响因子：
24.7
通讯作者：
Attfield, MD
中科院分区：
文献类型：
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作者：
Vallyathan, V;Brower, PS;Attfield, MD
本文对430例西弗吉尼亚州煤矿工人尸检的胸部X线片（CXR）与相应病理的关系进行了研究。对煤工尘肺（CWP）的以下病变的全肺切片进行了审查和四点严重程度量表分级：斑点，微小和大结节（小和大的纤维化结节），进行性块状纤维化（PMF）。由三名B阅片员使用1971年国际劳工组织（ILO）U/C分类对死前CXR进行分类（6）。病理检查发现，96%的矿工有斑疹，70%有小结节，45%有大结节，15%有矽肺，28%有PMF。通过CXR，69%的矿工有小的，圆形的不透明的类别大于或等于0/1。数据分析显示，随着结核等级的增加，检测到大于或等于0/1的小混浊的可能性越来越大。对于轻度至中度黄斑和轻度微结节的病例，经常报告0/0级的密集度。总的来说，q型混浊与斑疹和小结节相关，而大的r型混浊与大结节相关。CXR显示大阴影与病理性PMF有较好的相关性。然而，大约三分之一的病例被CXR确定为有大的阴影，但病理学没有证实为PMF。这些病例中有四分之一可以解释为肺部病变，如卡普兰结节，结核疤痕和肿瘤。同样，22%的病理学分类为PMF的病例通过CXR没有大的阴影。在这些病例中，有一半的放射科医生通过CXR发现了其他异常（癌症，结核病），如大的阴影。总体而言，该研究显示，对于病理性CWP病变，预测概率与观察到的大于或等于0/1的灌注类别缓解之间具有良好的一致性（Somer d = 0.64）。然而，该研究还表明，CXR对检测最小CWP病变不敏感，并且在存在伴随的肺部病理学时是不可靠的指标。
The relationships between chest radiographs (CXR) and corresponding pathology were investigated in 430 autopsied coal miners from West Virginia. Whole-lung sections were reviewed and graded on four-point severity scales for the following lesions of coal workers' pneumoconiosis (CWP): macules, micro- and macronodules (small and large fibrotic nodules), and progressive massive fibrosis (PMF). Antemortem CXR were classified by three B readers using the 1971 International Labor Office (ILO) U/C classification (6). On pathologic examination, 96% of miners had macules, 70% micronodules, 45% macronodules, 15% silicosis, and 28% PMF. By CXR, 69% of the miners had small, rounded opacity profusions of category greater than or equal to 0/1. Data analysis revealed increasing odds that small opacities of category greater than or equal to 0/1 would be detected with increasing grade of nodules. Profusion category 0/0 was often reported for cases with macules of mild to moderate grade and mild levels of micronodules. Overall, q-type opacities were associated with macules and micronodules, whereas the large r-type opacities were associated with macronodules. By CXR, large opacities showed good correlation with pathologic PMF. However, about one-third of cases identified as having large opacities by CXR were not substantiated as PMF by pathology. One-fourth of these cases could be explained by lung lesions such as Caplan's nodules, tuberculosis scars, and tumors. Similarly, 22% of cases classified as PMF on pathology had no large opacities by CXR. In half of these cases, the radiologists had noted other abnormalities (cancer, tuberculosis) by CXR as large opacities. Overall, the study showed good agreement (Somer's d = 0.64) between the predicted probabilities and observed responses of a profusion category greater than or equal to 0/1 for pathologic CWP lesions. However, the study also showed that CXR were insensitive for detecting minimal CWP lesions, and were unreliable indicators in the presence of concomitant pulmonary pathology.