Reply to letters to the editor by Brentisci et al. and Consonni and Mensi

We thank the authors of the letters to the editor [1.Brentisci C. Gangemi M. Migliore E. et al.Letter on ‘Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy.Ann Oncol. 2018; 29: 2395-2396Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 2.Consonni D. Mensi C. 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.Ann Oncol. 2019; 30: 340-341Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] for giving us the opportunity to clarify some details of our study [3.Boffetta P. Righi L. Ciocan C. 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: 484-489Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar]. The study included a total of 127 members of a cohort of Italian asbestos textile workers with a diagnosis of mesothelioma on the death certificate. Among them, 76 were matched through record linkage to the regional Mesothelioma Registry. It is plausible that most of the 51 individuals who were not matched did not qualify for inclusion in the Registry. Among the 35 matched individuals, whose diagnosis was confirmed during our review process, 29 were listed as confirmed cases in the regional Mesothelioma Registry, leading to an estimate of 83% sensitivity. Among the 10 matched individuals whose diagnosis either was not confirmed by pathology review, or was based on death certificate only, four were listed as confirmed cases in the Registry (specificity 60%; our original estimate of 41% specificity included additional cases without histologic verification in our analysis, but we think the new estimate is more appropriate). The comparison between our validation effort and the data of the regional Mesothelioma Registry, however, is subject to uncertainty because of the diagnostic criteria used in the Italian mesothelioma registration system [4.Marinaccio A. Binazzi A. Bonafede M. et al.Il Registro Nazionale dei Mesoteliomi. Sesto Rapporto. Inail, Rome2018Google Scholar]. This system includes, in addition to three subcategories of ‘confirmed’ cases with defined immunohistochemical, imaging or pathological criteria, a fourth option for cases ‘confirmed, not elsewhere specified’, whose diagnostic criteria are unclear. This subcategory comprised as much as 31% of all ‘confirmed’ cases in the latest national report of the Mesothelioma Registries [2.Consonni D. Mensi C. 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.Ann Oncol. 2019; 30: 340-341Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar], which includes the regional registry we used for our comparison, while only 57% of ‘confirmed’ cases in the same national Registries satisfied the immunohistochemical criteria recommended by international panels [5.Husain A.N. Colby T.V. Ordóñez N.G. et al.Guidelines for pathologic diagnosis of malignant mesothelioma: 2017 update of the consensus statement from the International Mesothelioma Interest Group.Arch Pathol Lab Med. 2018; 142: 89-108Crossref PubMed Scopus (303) Google Scholar], and used in our study [3.Boffetta P. Righi L. Ciocan C. 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: 484-489Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar]. We inadvertently did not mention in the original publication [3.Boffetta P. Righi L. Ciocan C. 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: 484-489Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar] potential conflicts unrelated to the submitted work. This has now been corrected. None declared.