Bibliographic record
Abstract
I thank Dr. Nabeshima for his comments1: he raises the important question of whether mesothelioma in situ (MIS) can be diagnosed by morphology alone or can only be diagnosed if no invasive mesothelioma appears within a certain time period. It's important to understand why we2 included a requirement for no invasive tumour diagnosed within 1 year in our original description of MIS; namely, we wanted to be sure that the morphology we were seeing was not just a surface spread of an existing invasive mesothelioma, because surface spread of an existing invasive mesothelioma was clearly what was illustrated in the very first, and in retrospect inaccurate, description of what was thought to be MIS by Whitaker et al. in 1992.3 But having used H&E/BAP1 immunostaining and sometimes MTAP immunostaining/CKDN2A FISH to establish a modern, and morphologically quite different, definition of the microscopic appearance of MIS, and having shown in our article (and supported by subsequent articles) that the majority of patients whose biopsies fit this definition will develop invasive mesothelioma sooner or later, I don't believe that a time delay is necessary before making a formal diagnosis of MIS. Rather, if a biopsy shows a picture of MIS, it is important to convey to clinicians that this process has a very high likelihood of progression to invasion and that additional workup/therapy is required. I agree completely with Dr. Nabeshima that some cases showing MIS on biopsy will be found to have a synchronous invasive mesothelioma elsewhere in the pleural or peritoneal cavity on further examination, and his suggestion that any evidence of progression (which probably means, in practice, radiologic change) is strongly suggestive of invasive disease. It is also important to bear in mind that imaging may not pick up the invasive component if there is only early disease, but that phenomenon does not invalidate the diagnosis of MIS; rather, it emphasizes the point that patients with a biopsy diagnosis of MIS always need further investigation. The author declares no conflict of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.060 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.004 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".