Interstitial Lung Abnormalities Detected by CT in Asbestos-Exposed Subjects Are More Likely Associated to Age

OBJECTIVE: the aim of this study was to evaluate the association between interstitial lung abnormalities, asbestos exposure and age in a population of retired workers previously occupationally exposed to asbestos. METHODS: previously occupationally exposed former workers to asbestos eligible for a survey conducted between 2003 and 2005 in four regions of France, underwent chest CT examinations and pulmonary function testing. Industrial hygienists evaluated asbestos exposure and calculated for each subject a cumulative exposure index (CEI) to asbestos. Smoking status information was also collected in this second round of screening. Expert radiologists performed blinded independent double reading of chest CT-scans and classified interstitial lung abnormalities into: no abnormality, minor interstitial findings, interstitial findings inconsistent with UIP, possible or definite UIP. In addition, emphysema was assessed visually (none, minor: emphysema 50% of the lung). Logistic regression models adjusted for age and smoking were used to assess the relationship between interstitial lung abnormalities and occupational asbestos exposure. RESULTS: the study population consisted of 2157 male subjects. Interstitial lung abnormalities were present in 365 (16.7%) and emphysema in 444 (20.4%). Significant positive association was found between definite or possible UIP pattern and age (OR adjusted =1.08 (95% CI: 1.02-1.13)). No association was found between interstitial abnormalities and CEI or the level of asbestos exposure. CONCLUSION: presence of interstitial abnormalities at HRCT was associated to aging but not to cumulative exposure index in this cohort of former workers previously occupationally exposed to asbestos

Deep Learning for the Automatic Quantification of Pleural Plaques in Asbestos-Exposed Subjects

OBJECTIVE: This study aimed to develop and validate an automated artificial intelligence (AI)-driven quantification of pleural plaques in a population of retired workers previously occupationally exposed to asbestos. METHODS: CT scans of former workers previously occupationally exposed to asbestos who participated in the multicenter APEXS (Asbestos PostExposure Survey) study were collected retrospectively between 2010 and 2017 during the second and the third rounds of the survey. A hundred and forty-one participants with pleural plaques identified by expert radiologists at the 2nd and the 3rd CT screenings were included. Maximum Intensity Projection (MIP) with 5 mm thickness was used to reduce the number of CT slices for manual delineation. A Deep Learning AI algorithm using 2D-convolutional neural networks was trained with 8280 images from 138 CT scans of 69 participants for the semantic labeling of Pleural Plaques (PP). In all, 2160 CT images from 36 CT scans of 18 participants were used for AI testing versus ground-truth labels (GT). The clinical validity of the method was evaluated longitudinally in 54 participants with pleural plaques. RESULTS: The concordance correlation coefficient (CCC) between AI-driven and GT was almost perfect (>0.98) for the volume extent of both PP and calcified PP. The 2D pixel similarity overlap of AI versus GT was good (DICE = 0.63) for PP, whether they were calcified or not, and very good (DICE = 0.82) for calcified PP. A longitudinal comparison of the volumetric extent of PP showed a significant increase in PP volumes (p < 0.001) between the 2nd and the 3rd CT screenings with an average delay of 5 years. CONCLUSIONS: AI allows a fully automated volumetric quantification of pleural plaques showing volumetric progression of PP over a five-year period. The reproducible PP volume evaluation may enable further investigations for the comprehension of the unclear relationships between pleural plaques and both respiratory function and occurrence of thoracic malignancy

Analyse des symptômes aigus et subaigus rapportés à l'utilisation de pesticides (enquête par questionnaire auprès d'une cohorte représentative des agriculteurs du Calvados)

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Inégalités dans la reconnaissance des maladies professionnelles en France

International audienceIn France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases

Mise en place d’une consultation spécialisée « Douleur et Travail » au CHU de Rouen

International audienc

Asthme professionnel allergique aux liliacées : à propos d’un cas

International audienceLes allergies professionnelles sont en très forte augmentation en France. L’asthme professionnel peut être provoqué par divers allergènes, selon les corps de métiers. Nous allons présenter un cas d’asthme professionnel à la tulipe, diagnostiqué en consultation pluridisciplinaire de médecine du travail et allergologie.MéthodesUne femme de 51 ans, fleuriste, était atteinte de toux, dyspnée et rhino-conjonctivite lors de l’effeuillage de tulipes, mais ne présentait ni altération de l’état général ni fièvre. Des tests de provocation bronchique à la tulipe ont été réalisés en milieu hospitalier. Des prick + prick-tests à la tulipe étaient réalisés avec le pistil, la feuille, l’étamine, la tige, la sève de la fleur. Ils ont également été réalisés chez deux témoins sains.RésultatsLe test de provocation bronchique à la métacholine ainsi que celui à l’effeuillage de tulipes étaient positifs. L’asthme à la tulipe était donc confirmé. Les prick-tests à la tulipe n’étaient positifs que chez la patiente, confirmant le mécanisme allergique IgE médié. Cliniquement, l’éviction de la tulipe par le changement de poste de travail a permis l’amendement complet de la symptomatologie.DiscussionL’asthme professionnel à la tulipe est peu connu. Seuls quatre autres cas similaires ont été précédemment décrits dans la littérature. La tulipe est plus connue en dermato allergologie car son allergène majeur, la tulipaline A, est responsable d’allergies de contact fréquentes, croisées avec d’autres fleurs.ConclusionNous rapportons un cas exceptionnel d’asthme professionnel à la tulipe chez une fleuriste. Son diagnostic de certitude nécessite une méthodologie rigoureuse et chronophage, facilitée par le cadre d’une consultation pluridisciplinaire de médecine du travail et d’allergologie

Thème maintien dans l'emploi Evaluation d'une consultation pluridisciplinaire d'aide au retour au travail après cancer

International audienceLa reprise du travail est une étape primordiale pour les patients atteints d’un cancer mais celle-ci peut s’avérer difficile et nécessiter un accompagnement adapté. Le Centre de consultations de pathologie professionnelle CHU de Rouen a créé, en 2006, une consultation pluridisciplinaire d’aide au retour au travail après un cancer. Les objectifs de cette étude descriptive étaient de présenter cette consultation, de connaitre le ressenti des patients vis-à-vis d’un tel dispositif et d’identifier des facteurs prédictifs de retour au travail

Impact psychologique du suivi post-professionnel amiante à long terme. Quelles conséquences après la déclaration suivie de la reconnaissance d’une maladie professionnelle chez des sujets de la cohorte SPP-A ?

National audienc

Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers.

International audienceOBJECTIVES: The aim was to compare, in a cohort of asbestos-exposed workers, the sensitivity and the specificity of low-radiation helical chest CT scan with chest radiograph for the biennial screening of bronchopulmonary cancer, according to the size of detected nodules. Material and METHODS: The screening procedure consisted of biennial chest radiograph and monodetector chest CT scan, given to 972 individuals who had been highly exposed to asbestos. A total of 2555 screening procedures were performed. The study focuses on the 1230 screening procedures for which a 2-year follow-up period was available. RESULTS: Twenty-four cases of bronchopulmonary cancer were diagnosed. CT scan detected 20 cancers, 12 of which had not been detected by chest radiograph. Sensitivity of chest radiograph and CT scan were, respectively, 33% and 83%, lesions measuring over 2 mm in diameter being considered as suspect. The specificity of chest radiograph and CT scan were, respectively, 95% and 78%. Calculation of the differential false positive/true positive (FP/TP) ratio and the receiver operating characteristic curve, performed for both chest radiograph and CT scan, facilitated the determination of the best possible compromise between specificity and sensitivity, according to the diameter threshold applied for considering a nodule as suspect. CONCLUSIONS: Although this study confirms the superior sensitivity of chest CT scan compared with conventional chest radiograph, the associated loss in specificity leads to a recommended diameter of 5 mm as the threshold for considering non-calcified lesions as "suspect", for the surveillance of asbestos-exposed individuals

Head and neck cancer and asbestos exposure

International audienceOBJECTIVES: The aim of this study was to analyse, within a French cohort of workers previously occupationally exposed to asbestos, incidence and mortality from various sites of head and neck cancers (larynx excluded) and to examine the potential link of these cancers with pleural plaques.METHODS: A 10-year follow-up study was conducted in the 13 481 male subjects included in the cohort between October 2003 and December 2005. Asbestos exposure was assessed by industrial hygienist analysis of a standardised questionnaire. The final cumulative exposure index (CEI; in equivalent fibres.years/mL) for each subject was calculated as the sum of each employment period's four-level CEI. The number of head and neck cancers recorded by the National Health Insurance fund was collected in order to conduct an incidence study. Complementary analysis was restricted to men who had performed at least one chest CT scan (N=4804). A mortality study was also conducted. We used a Cox model with age as the time axis variable adjusted for smoking, time since first exposure, CEI of exposure to asbestos and pleural plaques on CT scans.RESULTS: We reported a significant dose-response relationship between CEI of exposure to asbestos and head and neck cancers after exclusion of laryngeal cancers, in the mortality study (HR 1.03, 95% CI (1.01 to 1.06) for an increase of 10 f.years/mL) and a close to significant dose-response relationship in the incidence study (HR 1.02, 95% CI (1.00 to 1.04) for an increase of 10 f.years/mL). No statistically significant association between pleural plaques and head and neck cancer incidence was observed.CONCLUSIONS: This large-scale study suggests a relationship between asbestos exposure and head and neck cancers, after exclusion of laryngeal cancers, regardless of whether associated pleural plaques were present