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Asbestosis resembles many other diffuse interstitial lung diseases, including other pneumoconioses.
The differential diagnosis includes Idiopathic Pulmonary Fibrosis ( IPF ), Hypersensitivity pneumonitis, sarcoidosis, and others.
The presence of pleural plaquing may provide supportive evidence of causation by asbestos.
Although lung biopsy is usually not necessary, the presence of asbestos bodies in association with pulmonary fibrosis establishes the diagnosis.
Conversely, interstitial pulmonary fibrosis in the absence of asbestos bodies is most likely not asbestosis.
Asbestos bodies in the absence of fibrosis indicate exposure, not disease.

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