Reviewer's report
Title:Type V pit pattern: Impact of clinical experience and magnifying
chromoendoscopy
Version:3Date:25 February 2014
Reviewer: SHiro Oka
Reviewer's report:
Comments to authors (Major Revision)
The authors presented the reliability of type V pit pattern for early colorectal
cancer to diagnose invasion depth of SM 1000µm. The collected experience is
interesting. However, there are some problems with the current study that need
to be addressed. My suggestions are as follows:
Major comments
1. This study design has a bias of conventional image to diagnose the invasion
depth using magnifying chromoendoscopy image, especially in the experienced
endoscopists. To assess the reliability of type V pit pattern, it is better to evaluate
by magnifying chromoendoscopy image alone.
2. In the selected lesions, are there any LST lesions? Especially, LST-NG
pseudodepressed type (0-IIa+IIc) with type VI pit pattern (mild irregular) has a
possibility of SM deep invasion. The authors should describe this point.
3. In this study, did the endoscopists regard type VI pit pattern (severe irregular)
as the confirmation of SM deep invasion in all cases? It is important how to
evaluate the lesions with type VI pit pattern (severe irregular), because they have
SM scanty invasion or intramucosal cancer in some cases.
4. The kappa value for intra-observer agreement of type VI pit pattern
subclassication was relatively low. The authors discuss the reason more in the
Discussion.
5. How about the kappa value for intra-observer agreement of type Vn pit
pattern? The authors should mention the results about this point.
6. How was the mean value of the SM invasion depth in the lesions deeper than
1,000µm? The interpretation is greatly different in the lesions that exceed
1000µm a little or a lot.
7. The only 1 moderately differentiated adenocarcionoma should be excluded in
this study, because the pit pattern of the moderately differentiated
adenocarcionoma often looks worse compared with that of well differentiated
adenocarcionoma.
8. In the Table 3, what is a concrete numerical value of the SM depth in the SM-d
lesions?
9. In the Figure1, I recommend that the authors should change a more typical
picture of Vn pit pattern, because the distinction between non-structure and
mucus is difficult in this case.
10. The number of references about the clinical usefulness of pit pattern
diagnosis for the colorectal lesions is relatively small. I recommended that more
references should be cited.
11. The authors had better confirm the statistical method. Mann-Whitney U test
seem to be unsuitable to analyze between 3 groups.
Minor comment
1. P6 line 5. subcategeories # subcategories
2. P6 line 7. colorectal cancers # early colorectal cancers
3. Figure2. Please describe the group (I, II or III) clearly in the figure
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Type V pit pattern: Impact of clinical experience and magnifying
chromoendoscopy
Version:3Date:25 February 2014
Reviewer: SHiro Oka
Reviewer's report:
Comments to authors (Major Revision)
The authors presented the reliability of type V pit pattern for early colorectal
cancer to diagnose invasion depth of SM 1000µm. The collected experience is
interesting. However, there are some problems with the current study that need
to be addressed. My suggestions are as follows:
Major comments
1. This study design has a bias of conventional image to diagnose the invasion
depth using magnifying chromoendoscopy image, especially in the experienced
endoscopists. To assess the reliability of type V pit pattern, it is better to evaluate
by magnifying chromoendoscopy image alone.
2. In the selected lesions, are there any LST lesions? Especially, LST-NG
pseudodepressed type (0-IIa+IIc) with type VI pit pattern (mild irregular) has a
possibility of SM deep invasion. The authors should describe this point.
3. In this study, did the endoscopists regard type VI pit pattern (severe irregular)
as the confirmation of SM deep invasion in all cases? It is important how to
evaluate the lesions with type VI pit pattern (severe irregular), because they have
SM scanty invasion or intramucosal cancer in some cases.
4. The kappa value for intra-observer agreement of type VI pit pattern
subclassication was relatively low. The authors discuss the reason more in the
Discussion.
5. How about the kappa value for intra-observer agreement of type Vn pit
pattern? The authors should mention the results about this point.
6. How was the mean value of the SM invasion depth in the lesions deeper than
1,000µm? The interpretation is greatly different in the lesions that exceed
1000µm a little or a lot.
7. The only 1 moderately differentiated adenocarcionoma should be excluded in
this study, because the pit pattern of the moderately differentiated
adenocarcionoma often looks worse compared with that of well differentiated
adenocarcionoma.
8. In the Table 3, what is a concrete numerical value of the SM depth in the SM-d
lesions?
9. In the Figure1, I recommend that the authors should change a more typical
picture of Vn pit pattern, because the distinction between non-structure and
mucus is difficult in this case.
10. The number of references about the clinical usefulness of pit pattern
diagnosis for the colorectal lesions is relatively small. I recommended that more
references should be cited.
11. The authors had better confirm the statistical method. Mann-Whitney U test
seem to be unsuitable to analyze between 3 groups.
Minor comment
1. P6 line 5. subcategeories # subcategories
2. P6 line 7. colorectal cancers # early colorectal cancers
3. Figure2. Please describe the group (I, II or III) clearly in the figure
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Type V pit pattern: Impact of clinical experience and magnifying
chromoendoscopy
Version:3Date:25 February 2014
Reviewer: SHiro Oka
Reviewer's report:
Comments to authors (Major Revision)
The authors presented the reliability of type V pit pattern for early colorectal
cancer to diagnose invasion depth of SM 1000µm. The collected experience is
interesting. However, there are some problems with the current study that need
to be addressed. My suggestions are as follows:
Major comments
1. This study design has a bias of conventional image to diagnose the invasion
depth using magnifying chromoendoscopy image, especially in the experienced
endoscopists. To assess the reliability of type V pit pattern, it is better to evaluate
by magnifying chromoendoscopy image alone.
2. In the selected lesions, are there any LST lesions? Especially, LST-NG
pseudodepressed type (0-IIa+IIc) with type VI pit pattern (mild irregular) has a
possibility of SM deep invasion. The authors should describe this point.
3. In this study, did the endoscopists regard type VI pit pattern (severe irregular)
as the confirmation of SM deep invasion in all cases? It is important how to
evaluate the lesions with type VI pit pattern (severe irregular), because they have
SM scanty invasion or intramucosal cancer in some cases.
4. The kappa value for intra-observer agreement of type VI pit pattern
subclassication was relatively low. The authors discuss the reason more in the
Discussion.
5. How about the kappa value for intra-observer agreement of type Vn pit
pattern? The authors should mention the results about this point.
6. How was the mean value of the SM invasion depth in the lesions deeper than
1,000µm? The interpretation is greatly different in the lesions that exceed
1000µm a little or a lot.
7. The only 1 moderately differentiated adenocarcionoma should be excluded in
this study, because the pit pattern of the moderately differentiated
adenocarcionoma often looks worse compared with that of well differentiated
adenocarcionoma.
8. In the Table 3, what is a concrete numerical value of the SM depth in the SM-d
lesions?
9. In the Figure1, I recommend that the authors should change a more typical
picture of Vn pit pattern, because the distinction between non-structure and
mucus is difficult in this case.
10. The number of references about the clinical usefulness of pit pattern
diagnosis for the colorectal lesions is relatively small. I recommended that more
references should be cited.
11. The authors had better confirm the statistical method. Mann-Whitney U test
seem to be unsuitable to analyze between 3 groups.
Minor comment
1. P6 line 5. subcategeories # subcategories
2. P6 line 7. colorectal cancers # early colorectal cancers
3. Figure2. Please describe the group (I, II or III) clearly in the figure
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
assistant