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104 Morris Greenberg and T. A. Lloyd Davies mesotheliomas. Journal of Palhdoiy and Bacteriology, 84, 73-77. ------. Sieges. C A, and Marehud, P. (I960). DiffUso pleural mesothelioma and asbcsoi exposure in North Western Cepe Province. British Journal of Industrial Mediant, 17. 260-271. Whitwell. F. and Rawdiffe, Racist M. (1971). Diffuse malifoau pjeural mesothelioma and asbestos exposure. Thorax, 26, 6-22. Willis, R. A. (1932). The Spread of Tumours tn the Human Body, 2nd ed., p. 33. Butterwonta. Loudon. Received for publicailon May 17,1971 Accepted for publication July 20, 1973 If the two opinions lead to a blank entry above then the specimen should be sent to the two other readers and a combined diagnosis made on the basis of four readings. There are many possibilities from four readings but the combined diagnosis should follow the majority if there is a dear one and other* wise be undecided. The following rule is sufficient to determine all cases of four readings: score a definite as 1 point, probable as j, possible as 0, not as -- 1; then add up the four scores and if the total is greater than or equal to I j the diagnosis is Definite, between -- 1 and -t-1 inclusive it is Undecided, less than or equal to -- 1} is Not a mesothelioma.' Addendum APPENDIX. The Mesothelioma Register, which in 1967 and 1968 recorded cases from all available sources, has since continued with notifications of deceased cases only. The following table gives details ofnotifications (subject to confirmation) for the yean up to 1971, figures for the yean 1967 and 1968 being included on a similar basis for comparison. The UICC Panel of Pathologists and diagnostic criteria A British panel of pathologists specializing in the diagnosis of mesothelial tumours was formed unofficially in 1963 and consisted of Dr. K. F. W. Hinson, Dr. F. Whitwell, Professor W. F. E. McCaughey, and Dr. J. C Wagner. . From 1963 la 1967 all cases were examined by all members of the panel and a majority opinion was arrived at. Subsequently the panel'was constituted as a UICC panel. From 1967 panellists decided whether the diagnosis was definitely mesothelioma, definitely not mesothelioma or whether there was insufficient histological material, only referring material to another member or members of the panel in case of doubt. After mid-1968 the policy was adopted that all cases referred to the panel should be seen by at least two members and that if there was a difference of opinion a third opinion should be sought. In mid-1971 the followingprotocol was designed for combined panel diagnosis. Two opinions are necessary for diagnosis and these two opinions should be combined as below: Notifications to the Mesothelioma Register (Death Cases) 1967*71 Sourer* of Hoiificatiea Death cntificate Cancer Rejistry4 Industrial injury data* Other Tout 1967 1968 1969 1970 1971 91 119 m 163 124 39 23 20 11 1! 3 3' 6 30 13 5 3-- 53 to 231 137 134 131 'Not so certified at death *Not on death certificate ot cancer registration In the short period studied it is not possible to observe a significant trend. The large number of cases notified In 1968 may have resulted from the publicity and vigilance generated by the survey, iif the impression of a failing olTin notifications is con firmed then whether this will be due to a change in the prevalence of the disease or to a change in vigilance will require to be evaluated. 1 First opinion . Deftnito mesothelioma Probable mesothelioma Possible mesothelioma Not a mesothelioma Drfinitr Definite Definite .Second opinion ProbabU Pouibit Definite Undecided Undecided WWW Undecided Undecided Not Hoi ,. _ Not Not British Jama if Mortalr populat miners L.O.MtVF Department Of Cancer Regs? Mirar 31. iC-M misers is on uvre I93f'asd sex-mav death a. system fmevvte of Let;. under, for an aasho'.L-s cuo> o! aapncnr It has been Jar. in harmfj eri.- deferent J: 1 pleural or pan. Sonic oocnx from other mail difotitc organ Sellto'. t>urii. I>*t-*t iVnsOrf. the IVHvlVc dlfi from 1- avhtv.n er.nrra the v.vvi a ilitlrervxv (Tim nivui rapes ' I,Vrvw. )V` rapr of aihnuw