Schermer T R, Cox A L
Katholieke Universiteit, afd. Huisartsgeneeskunde, Sociale Geneeskunde en Verpleeghuisgeneeskunde, Nijmegen.
Ned Tijdschr Geneeskd. 1999 Nov 20;143(47):2354-60.
The incidence of malignant mesothelioma, the main consequence of exposure to asbestos, will increase considerably in the Netherlands in the coming decades. In the next 35 year, some 20,000 people will die from malignant mesothelioma. The diagnosis of malignant pleural mesothelioma in practice is based on histological examination in about 80%, on cytological examination in 15% and on other forms of examination, e.g., high resolution computer tomography (HRCT), in 6% of the cases. Using a combination of various noninvasive methods, such as anamnesis, physical and röntgenologic examination, HRCT and spirometry, the diagnosis of asbestosis is made erroneously in 5% of the patients examined. With regard to allowance of financial compensation to patients with pleural mesothelioma and asbestosis, a part is played by the fact that views differ internationally concerning the criteria on which the diagnosis should be based. For mesothelioma cytologic and histologic examination are the most important. For asbestosis, the Health Council considers HRCT as crucial, if necessary supplemented by histological examination, plus a history of exposure to asbestos and pulmonary dysfunction. In mesothelioma cytological and histological examination are the most important.
恶性间皮瘤是接触石棉的主要后果，在未来几十年里，荷兰恶性间皮瘤的发病率将大幅上升。在未来35年里，约2万人将死于恶性间皮瘤。在实际中，约80%的恶性胸膜间皮瘤诊断基于组织学检查，15%基于细胞学检查，6%基于其他检查形式，如高分辨率计算机断层扫描（HRCT）。使用各种非侵入性方法的组合，如问诊、体格检查、X线检查、HRCT和肺活量测定，在接受检查的患者中，有5%被错误诊断为石棉肺。关于胸膜间皮瘤和石棉肺患者的经济赔偿问题，国际上对于诊断应依据的标准存在不同观点，这在其中起到了一定作用。对于间皮瘤，细胞学和组织学检查最为重要。对于石棉肺，健康委员会认为HRCT至关重要，必要时辅以组织学检查，再加上接触石棉的病史和肺功能障碍。在间皮瘤中，细胞学和组织学检查最为重要。
