Reviewer ’s report  
 
Title: Bile cholesterol and viscosity, the keys to discriminating adenomatous polyps from  
cholesterol polyps by a novel predictive scoring model.  
 
Version: 0 Date: 19 May 2020  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
Yes - there is a clear objective  
 
DESIGN - Is the current approach (including controls  and analysis protocols) appropriate for the 
objective?  
Yes - the approach is appropriate  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
Yes - experiments and analyses were performed appropr iately  
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
No - there are issues with the statistics in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
No - there are majo r issues  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically sound? 
If not, can revisions be made to make the work technically sound?  
Maybe - with major revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
Overall, the manusc ript presents interesting clinical data regarding the discrimination of benign 
and premalignant gallbladder polyps. The authors have taken into consideration a number of 
clinical and histopathological characteristics, trying to analyze all possible variabl es. However, I 
am worried about the numbers of samples tested in each group (11 adenomatous polyps vs. 96 
cholesterol polyps), which is largely imbalanced.  
 
REQUESTED REVISIONS:  
Since one sample group is almost 9 times larger than the other (96 vs. 11), t he authors should show 
that the groups actually fulfill the three criteria for usage of Student's t -test, which in turn affects 
the results of the multivariate logistic regression. In case they do not fulfill the criteria, the authors 
should use non -parame tric tests for the univariate analyses. This conditions the credibility of the 
results and the path for the discussion.  
 
Are the methods app ropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusi ons drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an additional 
statistical review?  
If an additional sta tistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you recei ved reimbursements, fees, funding, or salary from an organization that holds 
or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' below. 
If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing i nterests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
Reviewer Publication Consent. I agree for my report to be made  available under an Open Access 
Creative Commons CC -BY License ( http://creativecommons .org/licenses/by/4.0 ) if t his 
manuscript is accepted for publication. Any comments that I do not wish to be included in the 
published report have been included as confidential comments to the editor, which will not be 
published.  If you are not happy for us to publish this report, please contact the edi torial office 
before completing the review.  If you wish, you can include your name in your publish ed report. 
Please note you must decide whether to include your name at the start of the process and confirm 
this decision whenever prompted. If you change your decision later, we will not be able to publish 
your name.  
 
I agree to the terms of the CC -BY 4.0 license; please do not publish my name with my report.  
(default)  
Reviewer ’s report  
 
Title: Bile cholesterol and viscosity, the keys to discriminating adenomatous polyps from  
cholesterol polyps by a novel predictive scoring model.  
 
Version: 0 Date: 19 May 2020  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
Yes - there is a clear objective  
 
DESIGN - Is the current approach (including controls  and analysis protocols) appropriate for the 
objective?  
Yes - the approach is appropriate  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
Yes - experiments and analyses were performed appropr iately  
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
No - there are issues with the statistics in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
No - there are majo r issues  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically sound? 
If not, can revisions be made to make the work technically sound?  
Maybe - with major revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
Overall, the manusc ript presents interesting clinical data regarding the discrimination of benign 
and premalignant gallbladder polyps. The authors have taken into consideration a number of 
clinical and histopathological characteristics, trying to analyze all possible variabl es. However, I 
am worried about the numbers of samples tested in each group (11 adenomatous polyps vs. 96 
cholesterol polyps), which is largely imbalanced.  
 
REQUESTED REVISIONS:  
Since one sample group is almost 9 times larger than the other (96 vs. 11), t he authors should show 
that the groups actually fulfill the three criteria for usage of Student's t -test, which in turn affects 
the results of the multivariate logistic regression. In case they do not fulfill the criteria, the authors 
should use non -parame tric tests for the univariate analyses. This conditions the credibility of the 
results and the path for the discussion.  
 
Are the methods app ropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusi ons drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an additional 
statistical review?  
If an additional sta tistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you recei ved reimbursements, fees, funding, or salary from an organization that holds 
or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' below. 
If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing i nterests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
Reviewer Publication Consent. I agree for my report to be made  available under an Open Access 
Creative Commons CC -BY License ( http://creativecommons .org/licenses/by/4.0 ) if t his 
manuscript is accepted for publication. Any comments that I do not wish to be included in the 
published report have been included as confidential comments to the editor, which will not be 
published.  If you are not happy for us to publish this report, please contact the edi torial office 
before completing the review.  If you wish, you can include your name in your publish ed report. 
Please note you must decide whether to include your name at the start of the process and confirm 
this decision whenever prompted. If you change your decision later, we will not be able to publish 
your name.  
 
I agree to the terms of the CC -BY 4.0 license; please do not publish my name with my report.  
(default)  
Please review this paper.
user
Reviewer ’s report  
 
Title: Bile cholesterol and viscosity, the keys to discriminating adenomatous polyps from  
cholesterol polyps by a novel predictive scoring model.  
 
Version: 0 Date: 19 May 2020  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
Yes - there is a clear objective  
 
DESIGN - Is the current approach (including controls  and analysis protocols) appropriate for the 
objective?  
Yes - the approach is appropriate  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
Yes - experiments and analyses were performed appropr iately  
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
No - there are issues with the statistics in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
No - there are majo r issues  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically sound? 
If not, can revisions be made to make the work technically sound?  
Maybe - with major revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
Overall, the manusc ript presents interesting clinical data regarding the discrimination of benign 
and premalignant gallbladder polyps. The authors have taken into consideration a number of 
clinical and histopathological characteristics, trying to analyze all possible variabl es. However, I 
am worried about the numbers of samples tested in each group (11 adenomatous polyps vs. 96 
cholesterol polyps), which is largely imbalanced.  
 
REQUESTED REVISIONS:  
Since one sample group is almost 9 times larger than the other (96 vs. 11), t he authors should show 
that the groups actually fulfill the three criteria for usage of Student's t -test, which in turn affects 
the results of the multivariate logistic regression. In case they do not fulfill the criteria, the authors 
should use non -parame tric tests for the univariate analyses. This conditions the credibility of the 
results and the path for the discussion.  
 
Are the methods app ropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusi ons drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an additional 
statistical review?  
If an additional sta tistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you recei ved reimbursements, fees, funding, or salary from an organization that holds 
or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' below. 
If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing i nterests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
Reviewer Publication Consent. I agree for my report to be made  available under an Open Access 
Creative Commons CC -BY License ( http://creativecommons .org/licenses/by/4.0 ) if t his 
manuscript is accepted for publication. Any comments that I do not wish to be included in the 
published report have been included as confidential comments to the editor, which will not be 
published.  If you are not happy for us to publish this report, please contact the edi torial office 
before completing the review.  If you wish, you can include your name in your publish ed report. 
Please note you must decide whether to include your name at the start of the process and confirm 
this decision whenever prompted. If you change your decision later, we will not be able to publish 
your name.  
 
I agree to the terms of the CC -BY 4.0 license; please do not publish my name with my report.  
(default)  
assistant