Asbestos-related diseases. Algorithm for forensic pathological diagnosis

The pathological diagnosis and proof of asbestos causation in environmental-occupational diseases is based on a spectrum of increasingly sophisticated determinations with greater confidence in detection of asbestos bodies and fibers. These include the following: pathology (histology) and/or thick smears of lung, microincineration, bulk chemical digestion, and electron beam instruments. The requisites of medical and forensic asbestos causation differ, and do not always require the full range of these analytical techniques. The need and significance of some of these determinations, as expressed in number of asbestos bodies and fibers, may be related in many cases to the evidence of asbestosis; to the gross and microscopic pathological findings (asbestosis, lung carcinoma, mesothelioma); the exposure history (type, duration, intensity, and period of latency); and nature of the asbestos mineral. An algorithm for the forensic pathological diagnosis of asbestosis and of asbestos-related diseases is proposed.