Reviewer's report
Title:Diagnostic Accuracy of Cyst Fluid Amphiregulin in Pancreatic Cysts
Version: 1Date:18 September 2011
Reviewer: Christopher Halloran
Reviewer's report:
This is a retrospective, but small study of analysis of pancreatic cyst fluid using
amphiregulin (AREG). The motivation was to use this novel biomarker to
differentiate between non-mucinous, benign mucinous and malignant mucinous
cysts. This is an important topic and the authors should be congratulated on their
endeavours in this field.
Major Revisions / Questions to be answered
It is unclear whether AREG use was investigated as a biomarker for
dysplasia/malignancy or for mucinous/non-mucinous lesions as suggested in the
abstract.
It would be helpful to know whether the pre-operative diagnoses differed from the
post operative histology and what the indications for surgery were.
This study attempts to differentiate between benign mucinous lesions and
mucinous lesions, which have dysplastic or malignant cells. However the
“benign” group contains 9 BD-IPMN, 3 MD-IPMN and 3 MCN. Practically
MD-IPMN and MCD should be treated as pre-malignant cysts and should be
resected regardless; therefore this use of tumour markers in these cases does
help.
Furthermore 3 cases of high-grade dysplasia were found in the MD-IPMN, which
were classified as “benign tumours”. Therefore was the analysis performed
between the benign cysts and the malignant cyst groups? in which case there
was bias or between those that were histologically benign with those of
dysplasia/malignancy? Hence I am not sure what the authors point is exactly –
clarification is required.
Looking at these data it is clear that MD-IPMN and MCD have a higher median
AREG and should never have been included in the grouping. These data are
summarized in table 3 that only have 9 patients not the 12 stated – where are the
rest. Overall this is VERY confusing as it is unclear exactly which patients were
compared.
As the data pertaing to which patients were used in the accuracy testing and
ROC curve are unclear I am hesitant to accept these findings without
qualification.
Overall the use of AREG performs no better than CEA in those cases where both
results are included. Obviously the small numbers and retrospective approach
hinder this study but it would be interesting to see how AREG performs along
side CEA and CA 199.9 from cyst aspirates in a prospective group of patients
presenting with non-inflammatory pancreatic cysts.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Diagnostic Accuracy of Cyst Fluid Amphiregulin in Pancreatic Cysts
Version: 1Date:18 September 2011
Reviewer: Christopher Halloran
Reviewer's report:
This is a retrospective, but small study of analysis of pancreatic cyst fluid using
amphiregulin (AREG). The motivation was to use this novel biomarker to
differentiate between non-mucinous, benign mucinous and malignant mucinous
cysts. This is an important topic and the authors should be congratulated on their
endeavours in this field.
Major Revisions / Questions to be answered
It is unclear whether AREG use was investigated as a biomarker for
dysplasia/malignancy or for mucinous/non-mucinous lesions as suggested in the
abstract.
It would be helpful to know whether the pre-operative diagnoses differed from the
post operative histology and what the indications for surgery were.
This study attempts to differentiate between benign mucinous lesions and
mucinous lesions, which have dysplastic or malignant cells. However the
“benign” group contains 9 BD-IPMN, 3 MD-IPMN and 3 MCN. Practically
MD-IPMN and MCD should be treated as pre-malignant cysts and should be
resected regardless; therefore this use of tumour markers in these cases does
help.
Furthermore 3 cases of high-grade dysplasia were found in the MD-IPMN, which
were classified as “benign tumours”. Therefore was the analysis performed
between the benign cysts and the malignant cyst groups? in which case there
was bias or between those that were histologically benign with those of
dysplasia/malignancy? Hence I am not sure what the authors point is exactly –
clarification is required.
Looking at these data it is clear that MD-IPMN and MCD have a higher median
AREG and should never have been included in the grouping. These data are
summarized in table 3 that only have 9 patients not the 12 stated – where are the
rest. Overall this is VERY confusing as it is unclear exactly which patients were
compared.
As the data pertaing to which patients were used in the accuracy testing and
ROC curve are unclear I am hesitant to accept these findings without
qualification.
Overall the use of AREG performs no better than CEA in those cases where both
results are included. Obviously the small numbers and retrospective approach
hinder this study but it would be interesting to see how AREG performs along
side CEA and CA 199.9 from cyst aspirates in a prospective group of patients
presenting with non-inflammatory pancreatic cysts.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Diagnostic Accuracy of Cyst Fluid Amphiregulin in Pancreatic Cysts
Version: 1Date:18 September 2011
Reviewer: Christopher Halloran
Reviewer's report:
This is a retrospective, but small study of analysis of pancreatic cyst fluid using
amphiregulin (AREG). The motivation was to use this novel biomarker to
differentiate between non-mucinous, benign mucinous and malignant mucinous
cysts. This is an important topic and the authors should be congratulated on their
endeavours in this field.
Major Revisions / Questions to be answered
It is unclear whether AREG use was investigated as a biomarker for
dysplasia/malignancy or for mucinous/non-mucinous lesions as suggested in the
abstract.
It would be helpful to know whether the pre-operative diagnoses differed from the
post operative histology and what the indications for surgery were.
This study attempts to differentiate between benign mucinous lesions and
mucinous lesions, which have dysplastic or malignant cells. However the
“benign” group contains 9 BD-IPMN, 3 MD-IPMN and 3 MCN. Practically
MD-IPMN and MCD should be treated as pre-malignant cysts and should be
resected regardless; therefore this use of tumour markers in these cases does
help.
Furthermore 3 cases of high-grade dysplasia were found in the MD-IPMN, which
were classified as “benign tumours”. Therefore was the analysis performed
between the benign cysts and the malignant cyst groups? in which case there
was bias or between those that were histologically benign with those of
dysplasia/malignancy? Hence I am not sure what the authors point is exactly –
clarification is required.
Looking at these data it is clear that MD-IPMN and MCD have a higher median
AREG and should never have been included in the grouping. These data are
summarized in table 3 that only have 9 patients not the 12 stated – where are the
rest. Overall this is VERY confusing as it is unclear exactly which patients were
compared.
As the data pertaing to which patients were used in the accuracy testing and
ROC curve are unclear I am hesitant to accept these findings without
qualification.
Overall the use of AREG performs no better than CEA in those cases where both
results are included. Obviously the small numbers and retrospective approach
hinder this study but it would be interesting to see how AREG performs along
side CEA and CA 199.9 from cyst aspirates in a prospective group of patients
presenting with non-inflammatory pancreatic cysts.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
assistant