Abstract：
Asbestos is a carcinogen that can cause lung cancer. The suspicion that a lung cancer diagnosis may be associated with exposure to asbestos has no bearing on treatment. However, attributing an individual\'s lung cancer to asbestos exposure has important medicolegal implications and may impact public health measures and policy. Simultaneous exposure(s) to other carcinogens (such as tobacco smoke, silica and many others) adds complexity while trying to answer the causation question. The Helsinki criteria were formulated to assist attributing lung cancer to previous asbestos exposure. Surrogate markers can be used and include signs of asbestosis and pleural plaques. The most widely used criterion for the presence of asbestosis is interstitial fibrosis in conjunction with 2 or more asbestos bodies/1 cm2 tissue section by light microscopy. Identification of asbestos bodies ty light pr electron microscopy provides an important element for asbestos diagnosis. However, fibrosis may be subtle, and the distribution of asbestos bodies is not uniform throughout the lungs, some types of asbestos fibres have low biopersistence, and not all types of asbestos readily form asbestos bodies. Additional criteria require knowledge of exposure history, which is often unknown to pathologists, but reliance on morphology in isolation may lead to mis-classification of interstitial lung disease as idiopathic. While a smoking-related lung cancer signature has emerged, an asbestos-related lung cancer signature has not yet been identified. In this review we will discuss practice points for the surgical pathologist.
摘要：
石棉是一种致癌物质，可导致肺癌。怀疑肺癌诊断可能与接触石棉有关，这与治疗无关。然而,将个人的肺癌归因于石棉暴露具有重要的法医学意义，并可能影响公共卫生措施和政策。同时暴露于其他致癌物（如烟草烟雾，二氧化硅和许多其他)在试图回答因果关系问题时增加了复杂性。制定赫尔辛基标准是为了帮助将肺癌归因于以前的石棉暴露。可以使用替代标记物，包括石棉沉着症和胸膜斑块的体征。最广泛使用的标准是通过光学显微镜检查与2个或更多石棉体/1cm2组织切片结合的间质纤维化。石棉体的鉴定为石棉诊断提供了重要的手段。然而,纤维化可能是微妙的，石棉体的分布在整个肺部并不均匀，某些类型的石棉纤维具有低生物持久性，并非所有类型的石棉都容易形成石棉体。其他标准需要了解接触史，病理学家通常不知道，但孤立依赖形态学可能导致间质性肺病错误分类为特发性。虽然与吸烟有关的肺癌特征已经出现，与石棉相关的肺癌特征尚未确定。在这篇综述中，我们将讨论外科病理学家的实践要点。
