Reviewer's report
Title:Imaging in assessing hepatic and peritoneal metastases of gastric cancer:
a systematic review
Version: 2Date:15 November 2010
Reviewer: Robert M Kwee
Reviewer's report:
1# 2. The standard of reference had to be a surgery and histopathological
examination.
How can this be done in patients who were negative for liver and/or metastases
on preoperative imaging?
2# The upper limit of search date was not limited, and lower limit was January
16, 2010.
What do the authors mean with this phrase? If the literature search was
conducted until January 2010, it should be updated now.
3# The authors excluded studies which included patients who received
chemotherapy
pre-operatively.
I wonder whether this is justified: at present, neoadjuvant chemotherapy is the
standard of care in patients with gastroesophageal cancer.
Please comment on this, and your reasons to exclude patients who received
chemotherapy pre-operatively.
4# QUADAS had 14 items. How can studies have a quality score of more than
17??
5# What are “midas and metandi commands”? Please shortly explain for the
clinical reader who is not familiar to these terms.
6# DOR, which means the ratio of the odds of positive test results in diseased
group relative to the odds of positive test results in non-diseased group, is
considered as another important indicator of test accuracy that combines the
data from sensitivity and specificity into a new index[52]. The value of a DOR
ranges from zero to infinity, with higher value indicating higher accuracy. A
DOR of 1.0 shows that a test can not distinguish between patients with the
disease and those without it.
This paragraph does not belong in the discussion.
7# Many of the included CT studies had a section thickness of 10 mm and some
even had an interslice gap of also 10 mm. Many studies did not describe the slice
thickness they used. It is obvious that these studies may have missed small
hepatic metastases. In our institution, for instance, we use a slice thickness of
3.0 mm without an interslice gap to detect liver metastases.
Therefore, the authors´ conclusion that that CT did not obtain consistently high
sensitivity and specificity in detecting liver and peritoneal metastases in patients
with gastric cancer may mislead the reader of the article.
8# More attention should be paid to laparoscopy, PET/CT, as well as new PET
tracers such as 18F-FLT in the detection of liver and peritoneal metastases of
gastric
cancer in future.
Why not focusing on diffusion-weighted MRI of the liver or whole-body DW MRI?
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
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:Imaging in assessing hepatic and peritoneal metastases of gastric cancer:
a systematic review
Version: 2Date:15 November 2010
Reviewer: Robert M Kwee
Reviewer's report:
1# 2. The standard of reference had to be a surgery and histopathological
examination.
How can this be done in patients who were negative for liver and/or metastases
on preoperative imaging?
2# The upper limit of search date was not limited, and lower limit was January
16, 2010.
What do the authors mean with this phrase? If the literature search was
conducted until January 2010, it should be updated now.
3# The authors excluded studies which included patients who received
chemotherapy
pre-operatively.
I wonder whether this is justified: at present, neoadjuvant chemotherapy is the
standard of care in patients with gastroesophageal cancer.
Please comment on this, and your reasons to exclude patients who received
chemotherapy pre-operatively.
4# QUADAS had 14 items. How can studies have a quality score of more than
17??
5# What are “midas and metandi commands”? Please shortly explain for the
clinical reader who is not familiar to these terms.
6# DOR, which means the ratio of the odds of positive test results in diseased
group relative to the odds of positive test results in non-diseased group, is
considered as another important indicator of test accuracy that combines the
data from sensitivity and specificity into a new index[52]. The value of a DOR
ranges from zero to infinity, with higher value indicating higher accuracy. A
DOR of 1.0 shows that a test can not distinguish between patients with the
disease and those without it.
This paragraph does not belong in the discussion.
7# Many of the included CT studies had a section thickness of 10 mm and some
even had an interslice gap of also 10 mm. Many studies did not describe the slice
thickness they used. It is obvious that these studies may have missed small
hepatic metastases. In our institution, for instance, we use a slice thickness of
3.0 mm without an interslice gap to detect liver metastases.
Therefore, the authors´ conclusion that that CT did not obtain consistently high
sensitivity and specificity in detecting liver and peritoneal metastases in patients
with gastric cancer may mislead the reader of the article.
8# More attention should be paid to laparoscopy, PET/CT, as well as new PET
tracers such as 18F-FLT in the detection of liver and peritoneal metastases of
gastric
cancer in future.
Why not focusing on diffusion-weighted MRI of the liver or whole-body DW MRI?
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
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:Imaging in assessing hepatic and peritoneal metastases of gastric cancer:
a systematic review
Version: 2Date:15 November 2010
Reviewer: Robert M Kwee
Reviewer's report:
1# 2. The standard of reference had to be a surgery and histopathological
examination.
How can this be done in patients who were negative for liver and/or metastases
on preoperative imaging?
2# The upper limit of search date was not limited, and lower limit was January
16, 2010.
What do the authors mean with this phrase? If the literature search was
conducted until January 2010, it should be updated now.
3# The authors excluded studies which included patients who received
chemotherapy
pre-operatively.
I wonder whether this is justified: at present, neoadjuvant chemotherapy is the
standard of care in patients with gastroesophageal cancer.
Please comment on this, and your reasons to exclude patients who received
chemotherapy pre-operatively.
4# QUADAS had 14 items. How can studies have a quality score of more than
17??
5# What are “midas and metandi commands”? Please shortly explain for the
clinical reader who is not familiar to these terms.
6# DOR, which means the ratio of the odds of positive test results in diseased
group relative to the odds of positive test results in non-diseased group, is
considered as another important indicator of test accuracy that combines the
data from sensitivity and specificity into a new index[52]. The value of a DOR
ranges from zero to infinity, with higher value indicating higher accuracy. A
DOR of 1.0 shows that a test can not distinguish between patients with the
disease and those without it.
This paragraph does not belong in the discussion.
7# Many of the included CT studies had a section thickness of 10 mm and some
even had an interslice gap of also 10 mm. Many studies did not describe the slice
thickness they used. It is obvious that these studies may have missed small
hepatic metastases. In our institution, for instance, we use a slice thickness of
3.0 mm without an interslice gap to detect liver metastases.
Therefore, the authors´ conclusion that that CT did not obtain consistently high
sensitivity and specificity in detecting liver and peritoneal metastases in patients
with gastric cancer may mislead the reader of the article.
8# More attention should be paid to laparoscopy, PET/CT, as well as new PET
tracers such as 18F-FLT in the detection of liver and peritoneal metastases of
gastric
cancer in future.
Why not focusing on diffusion-weighted MRI of the liver or whole-body DW MRI?
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
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