Reviewer's report
Title:Efficacy of Capillary Pattern Type IIIA/IIIB by Magnifying Narrow Band
Imaging for Estimating Depth of Invasion of Early Colorectal Neoplasms
Version: 2Date:14 December 2009
Reviewer: Ajay Bansal
Reviewer's report:
Re: 'Efficacy of Capillary Pattern Type IIIA/IIIB by Magnifying Narrow Band
Imaging for Estimating Depth of Invasion of Early Colorectal Neoplasms '
Response: This is an interesting study that applies NBI capillary patterns to
predict the depth of invasion. The rationale is strong but there are several
concerns.
Major Compulsory Revisions
1) The morphological appearance of colonic lesions plays an important role in
predicting the depth of invasion which then helps the endoscopist to decide the
therapeutic intervention. In methods, the authors suggest that each lesion was
classified using the Paris classification. The authors need to perform bivariate
analysis using both the NBI patterns and the Paris classification to determine the
independent effect of type IIIB patterns on predicting the depth of invasion.
2) Type IIIB pattern is described as avascular or loose microcapiilary vessels. To
me that almost suggests the appearance of an ulcer on the surface of these
lesions. Does type IIIA refers to presence of ulceration? It is known that surface
ulceration on colonic lesions portends higher stage.
3) It is not clear if the NBI patterns were predicted during real time endoscopy or
post priori from the collected images.
4) For observer variability studies, was any standardization done prior to the
image evaluation. What was the time difference between the first and the second
read?
5) The mean length was 17 mm (5-80 mm). The longer lengths will allow more
surface area to be visualized, so how did the authors select which images to
include.
6) A total of 130 colorectal lesions were identified. Why was the IOV performed
only on 115 lesions? Why were 15 lesions excluded?
7) The investigators have provided pairwise kappa values that are known to
make the agreement look better than it is. The authors should redo the kappa
analysis without classifying HI as control and provide an overall interobserver
and intraobserver kappa values for the three evaluators as a group.
Minor Essential Revisions
1) Discussion , 2nd page, 2nd to last paragraph. Replace “general” endoscopists
with less experienced.
2) Methods: The statement “CP type III lesions with an obvious appearance of
advanced cancer” needs to be further clarified to provide some objective
parameters
3) Results: The diagnostic accuracy usually refers to a combination of sensitivity
and specificity. If the authors are discussing NPV and PPV, mention it as such.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Efficacy of Capillary Pattern Type IIIA/IIIB by Magnifying Narrow Band
Imaging for Estimating Depth of Invasion of Early Colorectal Neoplasms
Version: 2Date:14 December 2009
Reviewer: Ajay Bansal
Reviewer's report:
Re: 'Efficacy of Capillary Pattern Type IIIA/IIIB by Magnifying Narrow Band
Imaging for Estimating Depth of Invasion of Early Colorectal Neoplasms '
Response: This is an interesting study that applies NBI capillary patterns to
predict the depth of invasion. The rationale is strong but there are several
concerns.
Major Compulsory Revisions
1) The morphological appearance of colonic lesions plays an important role in
predicting the depth of invasion which then helps the endoscopist to decide the
therapeutic intervention. In methods, the authors suggest that each lesion was
classified using the Paris classification. The authors need to perform bivariate
analysis using both the NBI patterns and the Paris classification to determine the
independent effect of type IIIB patterns on predicting the depth of invasion.
2) Type IIIB pattern is described as avascular or loose microcapiilary vessels. To
me that almost suggests the appearance of an ulcer on the surface of these
lesions. Does type IIIA refers to presence of ulceration? It is known that surface
ulceration on colonic lesions portends higher stage.
3) It is not clear if the NBI patterns were predicted during real time endoscopy or
post priori from the collected images.
4) For observer variability studies, was any standardization done prior to the
image evaluation. What was the time difference between the first and the second
read?
5) The mean length was 17 mm (5-80 mm). The longer lengths will allow more
surface area to be visualized, so how did the authors select which images to
include.
6) A total of 130 colorectal lesions were identified. Why was the IOV performed
only on 115 lesions? Why were 15 lesions excluded?
7) The investigators have provided pairwise kappa values that are known to
make the agreement look better than it is. The authors should redo the kappa
analysis without classifying HI as control and provide an overall interobserver
and intraobserver kappa values for the three evaluators as a group.
Minor Essential Revisions
1) Discussion , 2nd page, 2nd to last paragraph. Replace “general” endoscopists
with less experienced.
2) Methods: The statement “CP type III lesions with an obvious appearance of
advanced cancer” needs to be further clarified to provide some objective
parameters
3) Results: The diagnostic accuracy usually refers to a combination of sensitivity
and specificity. If the authors are discussing NPV and PPV, mention it as such.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Efficacy of Capillary Pattern Type IIIA/IIIB by Magnifying Narrow Band
Imaging for Estimating Depth of Invasion of Early Colorectal Neoplasms
Version: 2Date:14 December 2009
Reviewer: Ajay Bansal
Reviewer's report:
Re: 'Efficacy of Capillary Pattern Type IIIA/IIIB by Magnifying Narrow Band
Imaging for Estimating Depth of Invasion of Early Colorectal Neoplasms '
Response: This is an interesting study that applies NBI capillary patterns to
predict the depth of invasion. The rationale is strong but there are several
concerns.
Major Compulsory Revisions
1) The morphological appearance of colonic lesions plays an important role in
predicting the depth of invasion which then helps the endoscopist to decide the
therapeutic intervention. In methods, the authors suggest that each lesion was
classified using the Paris classification. The authors need to perform bivariate
analysis using both the NBI patterns and the Paris classification to determine the
independent effect of type IIIB patterns on predicting the depth of invasion.
2) Type IIIB pattern is described as avascular or loose microcapiilary vessels. To
me that almost suggests the appearance of an ulcer on the surface of these
lesions. Does type IIIA refers to presence of ulceration? It is known that surface
ulceration on colonic lesions portends higher stage.
3) It is not clear if the NBI patterns were predicted during real time endoscopy or
post priori from the collected images.
4) For observer variability studies, was any standardization done prior to the
image evaluation. What was the time difference between the first and the second
read?
5) The mean length was 17 mm (5-80 mm). The longer lengths will allow more
surface area to be visualized, so how did the authors select which images to
include.
6) A total of 130 colorectal lesions were identified. Why was the IOV performed
only on 115 lesions? Why were 15 lesions excluded?
7) The investigators have provided pairwise kappa values that are known to
make the agreement look better than it is. The authors should redo the kappa
analysis without classifying HI as control and provide an overall interobserver
and intraobserver kappa values for the three evaluators as a group.
Minor Essential Revisions
1) Discussion , 2nd page, 2nd to last paragraph. Replace “general” endoscopists
with less experienced.
2) Methods: The statement “CP type III lesions with an obvious appearance of
advanced cancer” needs to be further clarified to provide some objective
parameters
3) Results: The diagnostic accuracy usually refers to a combination of sensitivity
and specificity. If the authors are discussing NPV and PPV, mention it as such.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests
assistant