Letter to the Editor
Contributions of the High Resolution Computed Tomography in the Early Detection of Silicosis
Aportaciones de la tomografía axial computarizada de alta resolución en la detección precoz de silicosis
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We are concerned that our findings – and the conclusions drawn from them – have been described as mere opinions. The authors, by using only the International Classification of Radiographs in Pneumoconiosis of the International Labor Organization to argue against the validity of our results, appear to overlook the fact that the diagnosis were based primarily on the anatomical pathology results of four lung biopsies obtained by video-assisted thoracoscopy. When confirmation of a cluster of silicosis cases was received from the pathology department, high-resolution computed tomography (HRCT) was used to confirm the diagnosis in patients who were already symptomatic, nine of whom showed no changes on standard chest X-ray (CXR). Eight of these patients have currently been diagnosed with silicosis, including two who have developed complicated chronic silicosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In our procedures for screening and monitoring exposed workers, we do not underestimate the historically proven value of CXR. Nevertheless, after the appearance of several very severe cases, one terminating in death and another two waitlisted for lung transplantation, and in the context of the cluster described, HRCT, an accessible test with a very high positive predictive value, was used to improve the quality of the diagnosis. In an original article,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> we raise the issue of difficulty in interpreting CXR, which were initially judged normal in some patients. Other authors have mentioned limitations such as wide inter-evaluator variability and underdetection in the diagnosis of silicosis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> In contrast, HRCT provides more information than CXR, particularly in the early stages of the disease,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> as we were able to confirm in our series. HRCT is more sensitive and specific in the diagnosis of silicosis, revealing early subpleural rounded opacities in the lower lobes or mediastinal lymph nodes that could not be visualized on CXR.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> The advantages of HRCT are substantial, since if silicosis is detected early in an exposed worker, quicker action can be taken to adapt the subject's employment and to reduce the chances of disease progression.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thus, it seems unreasonable to dismiss as alarmist the publication of this series of cases associated with preventable exposure and serious consequences for public health, simply because they do not follow a standard diagnostic protocol. Indeed, standard diagnostic procedures were not ignored, they were only improved under the specific conditions of our clinical investigation. We are convinced that our study, and both the reflections that arose <span class="elsevierStyleItalic">a posteriori</span> and the general hypotheses generated from our initial findings are ethically correct, do not involve any conflict of interest, and respond to society's expectations of scientists. In this respect, one of the aims of the article was to combine our efforts with those of other clinicians and researchers interested in broadening our understanding of both the disease and the multiple interventions needed to reduce the impact of this form of silicosis in synthetic stone workers,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> some of which have already been put into practice. We hope that these additional clarifications will be useful for advancing on both fronts.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez-Alonso A, Córdoba-Doña JA, García-Vadillo C. Aportaciones de la tomografía axial computarizada de alta resolución en la detección precoz de silicosis. Arch Bronconeumol. 2015;51:528–529.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Martínez González C, Fernández Álvarez R, Pere Casan C. 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Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Litos: La revista de la piedra natural" "fecha" => "2013" "volumen" => "118" "paginaInicial" => "44" "paginaFinal" => "52" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000010/v1_201509302252/S1579212915002840/v1_201509302252/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000010/v1_201509302252/S1579212915002840/v1_201509302252/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915002840?idApp=UINPBA00003Z" ]
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| 2017 August | 18 | 12 | 30 |
| 2017 July | 20 | 8 | 28 |
| 2017 June | 42 | 36 | 78 |
| 2017 May | 28 | 15 | 43 |
| 2017 April | 33 | 11 | 44 |
| 2017 March | 20 | 8 | 28 |
| 2017 February | 18 | 9 | 27 |
| 2017 January | 9 | 3 | 12 |
| 2016 December | 21 | 7 | 28 |
| 2016 November | 28 | 11 | 39 |
| 2016 October | 35 | 11 | 46 |
| 2016 September | 35 | 20 | 55 |
| 2016 August | 41 | 9 | 50 |
| 2016 July | 30 | 6 | 36 |
| 2016 May | 0 | 5 | 5 |
| 2016 April | 0 | 1 | 1 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 17 | 18 |
| 2016 January | 0 | 5 | 5 |
| 2015 October | 1 | 1 | 2 |
Show all
