Chronological trends in the causation of malignant mesothelioma: Fiber burden analysis of 619 cases over four decades.
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2023-08
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Abstract
Malignant mesothelioma is a relatively rare malignancy with a strong association with prior asbestos exposure. A percentage of cases is not related to asbestos, and fiber analysis of lung tissue is a useful methodology for identifying idiopathic or spontaneous cases. We have performed fiber analyses in more than 600 cases of mesothelioma over the past four decades and were interested in looking for trends in terms of fiber types and concentrations as well as percentages of cases not related to asbestos. Demographic information was also considered including patient age, gender, and tumor location (pleural vs. peritoneal). The histologic pattern of the tumor and the presence or absence of pleural plaques or asbestosis were noted. Fiber analysis was performed in 619 cases, using the sodium hypochlorite technique for digestion of lung tissue samples. Asbestos bodies were counted by light microscopy (LM) and coated and uncoated fibers by scanning electron microscopy (EM). The results were stratified over four decades. Trends that were observed included increasing patient age, increasing percentage of women, increasing percentage of peritoneal cases, and increasing percentage of epithelial histological type. There was a decreasing trend in the percentage of patients with concomitant asbestosis (p < 0.001). The percentage of cases with an elevated lung asbestos content decreased from 90.5% in the 1980s to 54.1% in the 2010s (p < 0.001). This trend also held when the analysis was limited to 490 cases of pleural mesothelioma in men (91.8% in the 1980s vs. 65.1% in the 2010s). There was a decrease in the median asbestos body count by LM from 1390 asbestos bodies per gram of wet lung in the 1980s to 38 AB/gm in the 2010s. Similar trends were observed for each of the asbestos fiber types as detected by EM. We conclude that there has been a progressive decrease in lung fiber content of mesothelioma patients during the past four decades, with an increasing percentage of cases not related to asbestos and an increase in median patient age.
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Roggl, Victor L, Cynthia L Green, Beiyu Liu, John M Carney, Carolyn H Glass and Elizabeth N Pavlisko (2023). Chronological trends in the causation of malignant mesothelioma: Fiber burden analysis of 619 cases over four decades. Environmental research, 230. p. 114530. 10.1016/j.envres.2022.114530 Retrieved from https://hdl.handle.net/10161/33716.
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Scholars@Duke
Cynthia Lea Green
Survival Analysis
Longitudinal Data Analysis
Logistic Regression
Missing Data
Clinical Trial Methods
Maximum Likelihood Methods
Beiyu Liu
Overview: Beiyu currently collaborates with clinicians, residents and fellows in the Department of Surgery, Department of Dermatology, and Pharmacy. He has extensive biomedical research experience and his specific areas of interest include regression analysis, predictive modeling, survival analysis, and observational studies.
John Michael Carney
Carolyn Glass
Division Chief, Cardiovascular Pathology
Co-Director, Division of Artificial Intelligence and Computational Pathology
Associate Director, Residency Program
Director, Duke University Hospital Autopsy Service
Dr. Glass completed medical residency in Anatomic Pathology at the Brigham and Women’s Hospital/Harvard Medical School followed by fellowships in Cardiothoracic Pathology also at Brigham and Women’s Hospital/Harvard Medical School and Pulmonary/Cardiac Transplant Pathology at the University of Texas Southwestern Medical Center. Dr. Glass initially trained as a vascular surgeon with a focus on endovascular/interventional procedures through the 0+5 Integrated Vascular Surgery Program at the University of Rochester Medical Center from 2007-2011. As a recipient of the NIH National Lung Blood Institute T32 Ruth Kirschstein National Service Research Award, she completed a Ph.D with a concentration in Genomics and Epigenetics in 2014. Dr. Glass serves as P.I. of multiple NIH grants, including U54 and SBIR.
As a thoracic surgical pathologist, Dr. Glass diagnoses complex heart transplant rejection and thoracic malignancies. She works closely with the Duke Thoracic Oncology Group, DCI Center for Cancer Immunotherapy, Duke Division of Cardiovascular Medicine and Cardiothoracic Surgery and Pratt School of Biomedical Engineering.
Dr. Glass is the recipient of the Society of Cardiovascular Pathology (SCVP) Young Investigator’s Award, the William von Liebig Vascular Biology Research Fellowship at the Harvard Institutes of Medicine, the Duke Pathology Salvatore V. Pizzo Faculty Research Mentor Award, the Duke Department of Pathology Early Career Research Achievement Award and is author of over 100 publications (including book chapters in the recent W.H.O. Classification Tumours of the Lung, Pleura, Thymus and Heart) and 50 national presentations in cardiovascular disease, thoracic malignancies, surgery and machine learning.
In addition to her clinical and research activities, Dr. Glass has served on the Executive/National Committees for the Society of Cardiovascular Pathology, College of American Pathology Artificial Intelligence Committee and the Duke School of Medicine Executive Admissions Committee.
Elizabeth N Pavlisko
Dr. Pavlisko holds an undergraduate degree in Biochemistry from Clemson University and received her Doctor of Medicine from the Medical University of South Carolina. She completed her residency and is board certified in both Anatomic and Clinical Pathology. She trained as a pulmonary/thoracic pathology fellow at Duke University Medical Center under the mentorship of Drs. Victor Roggli and Thomas Sporn, two of the world’s leading Pulmonary Pathologist with expertise in pneumoconiosis and mesothelioma. She joined the faculty at Duke in 2011 as an Assistant Professor of Pathology, and her work is focused in thoracic, cardiovascular and transplant pathology as well as postmortem examination. Since starting her independent position, Dr. Pavlisko has developed expertise in neoplastic and non-neoplastic diseases of the lung and mediastinum with a special interest in lung transplantation and diseases of the pleura for which she is widely recognized as an authority. She currently serves as Chief of the Pulmonary/Thoracic Pathology Section.
Dr. Pavlisko’s clinical activities encompass pulmonary/thoracic and cardiovascular pathology, including transplantation, biomarker testing and autopsy pathology. Her primary research focus has centered on malignant mesothelioma and chronic lung allograft dysfunction (CLAD). She has published over 65 manuscripts and has 6 book chapters, the latter all centered on occupational diseases of the lungs and pleura. Since 2017, Dr. Pavlisko has co-chaired the lung steering committee for the Banff Foundation for Allograft Pathology. She is also an active member of the International Society for Heart and Lung Transplantation. Dr. Pavlisko has collaborations with the Departments of Pulmonary, Allergy and Critical Care Medicine and Cardiothoracic Surgery.
In addition to her clinical and research activities, Dr. Pavlisko is active in Duke University Hospital’s Clinical Laboratories and currently serves as the Medical Director of the Division of Anatomic Pathology and Digital Analytics (DAPDA) Laboratory, which includes Histology, Immunohistochemistry, FISH, and Image Analysis.
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