RADIOGRAPHIC AND PATHOLOGICAL CORRELATION OF COAL-WORKERS PNEUMOCONIOSIS

The relationships between chest radiographs (CXR) and corresponding pa thology were investigated in 430 autopsied coal miners from West Virgi nia. Whole-lung sections were reviewed and graded on four-point severi ty scales for the following lesions of coal workers' pneumoconiosis (C WP): macules, micro- and macronodules (small and large fibrotic nodule s), and progressive massive fibrosis (PMF). Antemortem CXR were classi fied 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% P MF. By CXR, 69% of the miners had small, rounded opacity profusions of category greater than or equal to 0/1. Data analysis revealed increas ing odds that small opacities of category greater than or equal to 0/1 would be detected with increasing grade of nodules. Profusion categor y 0/0 was often reported for cases with macules of mild to moderate gr ade and mild levels of micronodules. Overall, q-type opacities were as sociated with macules and micronodules, whereas the large r-type opaci ties were associated with macronodules. By CXR, large opacities showed good correlation with pathologic PMF. However, about one-third of cas es identified as having large opacities by CXR were not substantiated as PMF by pathology. One-fourth of these cases could be explained by l ung lesions such as Caplan's nodules, tuberculosis scars, and tumors. Similarly, 22% of cases classified as PMF on pathology had no large op acities by CXR. In half of these cases, the radiologists had noted oth er abnormalities (cancer, tuberculosis) by CXR as large opacities. Ove rall, the study showed good agreement (Somer's d = 0.64) between the p redicted 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.