Comment on the paper 'Boffetta et al. Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy. Ann Oncol 2018; 29(2): 484-489'

Our plain-English summary of Comment on the paper 'Boffetta et al. Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy. Ann Oncol 2018; 29(2): 484-489', by D. Consonni, C. Mensi (Annals of Oncology, 2019).

The study

• Authors: D. Consonni, C. Mensi
• Journal: Annals of Oncology
• Published: 2019;30(2):340-341
• Type of article: Letter, Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This letter to the editor challenged calculations in an earlier paper by Boffetta and colleagues. That paper reviewed diagnoses for 127 deaths from pleural or peritoneal cancers among workers at an asbestos textile factory in Piedmont, Italy, and compared them with the regional mesothelioma registry. Using its own diagnostic review as the reference and counting only registry cases classed as 'certain' mesothelioma as positive, it reported a registry sensitivity of 83% and specificity of 34%. The letter's authors argued this was incorrect. Counting certain, probable and possible registry cases, they found all 35 pathology-confirmed cases were listed as mesothelioma, giving a sensitivity of 100%. They called it a mistake to count the unreviewed cases in two table columns as non-mesothelioma when the registry had classified 40 of them as mesothelioma. They put specificity at 100%, noting this assumed five unreviewed non-mesothelioma cases would have been confirmed as such. The authors concluded that the data showed the registry was of high quality. They also questioned the earlier authors' declaration of no conflicts of interest. The letter's authors disclosed serving as Court experts in criminal asbestos cases.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor re-analysing figures published in another paper (Boffetta et al., Ann Oncol 2018)
• Who was studied: The 127 deaths from pleural or peritoneal cancers (or malignant mesotheliomas) among workers at an asbestos textile factory in Piedmont, Italy, as reported in the Boffetta et al. paper. Of these, 35 had pathology confirmation and 76 were listed in the Regional Mesothelioma Registry of Piedmont.
• Exposure: Work at an asbestos textile factory. No fiber types are named in the letter.
• Main results:
  • Taking its own diagnostic validation as the gold standard, the original paper reported a registry sensitivity of 83% and a specificity of 34% for 'certain confirmed mesothelioma versus other'. The letter's authors argued these calculations were incorrect.
  • For 35 cases, pathology samples were retrieved and the mesothelioma diagnosis was confirmed by morphological and immunohistochemical review.
  • 76 of the 127 cases were listed in the registry: 56 as certain, 19 as probable/possible and 1 as non-mesothelioma.
  • Counting all registry mesotheliomas, including probable and possible ones, the letter's authors calculated a registry sensitivity of (29+6)/35 = 100% among the 35 pathology-confirmed cases.
  • The authors argued it was a mistake to count the cases in the two central table columns, which had no diagnostic validation, as non-mesothelioma, given that the registry classified 40 of them as mesothelioma.
  • Assuming the five non-mesothelioma cases would have been confirmed as such, the authors calculated a specificity of (1+4)/5 = 100%.
  • The authors gave several reasons why many cases were missing from the registry, including death before the registry began in 1993 (31 cases).
• The authors' conclusion: The authors concluded that, contrary to the original paper, the available data showed a high quality of the Regional Mesothelioma Registry of Piedmont. They also questioned the original authors' declaration of no conflicts of interest, citing consulting roles and relationships with law offices reported in another paper.
• Limitations the authors state:
  • The authors acknowledged that, strictly speaking, the five non-mesothelioma cases had not undergone diagnostic revision. Their 100% specificity figure rests on the assumption that immunohistochemistry would have confirmed them as non-mesothelioma.
  • The authors disclosed that they had served as experts for the Court in criminal litigation about asbestos-related diseases.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, BAP1.

Related studies

• Comment on 'Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy' — C. Brentisci, M. Gangemi, et al. (2018)
• Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy — P. Boffetta, L. Righi, et al. (2018)
• Differential Diagnosis of Malignant Pleural Mesothelioma on Cytology: A Gene Expression Panel versus BRCA1-Associated Protein 1 and p16 Tests — R. Bruno, G. Alì, et al. (2020)
• Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053 — D. Mirabelli, A. Angelini, et al. (2021)
• Reply to Mirabelli et al. Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on "Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053" — S.D. Visonà, S. Capella, et al. (2021)
• Mortality of Talc Miners and Millers From Val Chisone, Northern Italy: An Updated Cohort Study — E. Pira, M. Coggiola, et al. (2017)

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