Title: Coexistence of early gastric cancer and benign submucosal lesions mimic invasive cancer:
a retrospective multicenter experience
Version: 2 Date: 17 Jul 2023
Reviewer's report:
Early gastric cancer coexisting with submucosal lesions with morphology similar to advanced
cancer is often treated with excessive surgical resection. This study reports that gastritis cystica
profunda is the most common submucosal lesions and provides a useful algorithm for accurately
diagnosing cases amenable to endoscopic treatment.
However, we believe that the following points should also be mentioned.
1) The authors need to further clarify the rationale for their proposed predictive factors.
It should be mentioned whether the proposed predictors are based on the results of the present
study or on previous reports.
2) How many of these 18 cases fit the predictors? For example, it would be better to say how
many of the 18 cases met 4 or more of the predictors.
3) How to accurately diagnose the of submucosal tumor in cases where EUS cannot diagnose
submucosal tumor (4 cases) is an important point. It should be mentioned how such cases were
diagnosed in this report. If cystic lesions could not be accurately diagnosed, what were they
diagnosed as?
4) The second part of the algorithm (Figure 7) should consider the classification of cases in
which submucosal tumors could or could not be evaluated correctly by EUS.
Also, does this algorithm mean that endoscopic resection should be considered when a
submucosal cystic lesion including gastritis cystica profunda is suspected? I would like to know
the opinion of the author.
5) It seems to me that there is little need to make a diagnosis based on endoscopic findings alone,
and I would like you to mention whether there have been any cases in which the presence of a
submucosal tumor has been accurately diagnosed by CT or MRI, which are imaging modalities
other than EUS. Specifically, are there any cases in which the diagnosis was made using T2-
weighted MRI images?
Title: Coexistence of early gastric cancer and benign submucosal lesions mimic invasive cancer:
a retrospective multicenter experience
Version: 2 Date: 17 Jul 2023
Reviewer's report:
Early gastric cancer coexisting with submucosal lesions with morphology similar to advanced
cancer is often treated with excessive surgical resection. This study reports that gastritis cystica
profunda is the most common submucosal lesions and provides a useful algorithm for accurately
diagnosing cases amenable to endoscopic treatment.
However, we believe that the following points should also be mentioned.
1) The authors need to further clarify the rationale for their proposed predictive factors.
It should be mentioned whether the proposed predictors are based on the results of the present
study or on previous reports.
2) How many of these 18 cases fit the predictors? For example, it would be better to say how
many of the 18 cases met 4 or more of the predictors.
3) How to accurately diagnose the of submucosal tumor in cases where EUS cannot diagnose
submucosal tumor (4 cases) is an important point. It should be mentioned how such cases were
diagnosed in this report. If cystic lesions could not be accurately diagnosed, what were they
diagnosed as?
4) The second part of the algorithm (Figure 7) should consider the classification of cases in
which submucosal tumors could or could not be evaluated correctly by EUS.
Also, does this algorithm mean that endoscopic resection should be considered when a
submucosal cystic lesion including gastritis cystica profunda is suspected? I would like to know
the opinion of the author.
5) It seems to me that there is little need to make a diagnosis based on endoscopic findings alone,
and I would like you to mention whether there have been any cases in which the presence of a
submucosal tumor has been accurately diagnosed by CT or MRI, which are imaging modalities
other than EUS. Specifically, are there any cases in which the diagnosis was made using T2-
weighted MRI images?
Please review this paper.
user
Title: Coexistence of early gastric cancer and benign submucosal lesions mimic invasive cancer:
a retrospective multicenter experience
Version: 2 Date: 17 Jul 2023
Reviewer's report:
Early gastric cancer coexisting with submucosal lesions with morphology similar to advanced
cancer is often treated with excessive surgical resection. This study reports that gastritis cystica
profunda is the most common submucosal lesions and provides a useful algorithm for accurately
diagnosing cases amenable to endoscopic treatment.
However, we believe that the following points should also be mentioned.
1) The authors need to further clarify the rationale for their proposed predictive factors.
It should be mentioned whether the proposed predictors are based on the results of the present
study or on previous reports.
2) How many of these 18 cases fit the predictors? For example, it would be better to say how
many of the 18 cases met 4 or more of the predictors.
3) How to accurately diagnose the of submucosal tumor in cases where EUS cannot diagnose
submucosal tumor (4 cases) is an important point. It should be mentioned how such cases were
diagnosed in this report. If cystic lesions could not be accurately diagnosed, what were they
diagnosed as?
4) The second part of the algorithm (Figure 7) should consider the classification of cases in
which submucosal tumors could or could not be evaluated correctly by EUS.
Also, does this algorithm mean that endoscopic resection should be considered when a
submucosal cystic lesion including gastritis cystica profunda is suspected? I would like to know
the opinion of the author.
5) It seems to me that there is little need to make a diagnosis based on endoscopic findings alone,
and I would like you to mention whether there have been any cases in which the presence of a
submucosal tumor has been accurately diagnosed by CT or MRI, which are imaging modalities
other than EUS. Specifically, are there any cases in which the diagnosis was made using T2-
weighted MRI images?
assistant