Title: Confocal endomicroscopy diagnostic criteria for early signet-ring cell carcinoma in
hereditary diffuse gastric cancer
Version: 1 Date: 13 Dec 2021
Reviewer:  Cristina Trovato
Reviewer's report:
The manuscript is readable and the Authors well elucidated limitations.
The Authors hypothesized that probe-based confocal laser endomicroscopy (pCLE) might help
diagnose early cancerous lesions in the context of HDGC.
In a previous report (Schueler SA et al, 2021) pCLE alone has low sensitivity for occult cancer
detection in CDH1 variant carriers, but in this paper a systematic approach to identification of
diagnostic criteria has not been used.
In this study the Authors used a strict multi-stage process to identify and validate off-line pCLE
criteria for a diagnosis of signet ring cell carcinoma (SRCC). The criteria identified have 81%
sensitivity and 71% specificity. These do not relate to the signet ring cells per se, but rather
reflect indirect effects on the tissue architecture of the SRCC foci. Real-time validation of these
criteria is required.
Specific Comments:
1) References style requires revision.
2) Reference n. 22 is incomplete, better to cite it as follows: Schueler SA, Gamble LA, Curtin
BF, Ruff SM, Connolly M, Hannah C, et al. Evaluation of confocal laser endomicroscopy for
detection of occult gastric carcinoma in CDH1 variant carriers. J Gastrointest Oncol. 2021
Apr;12(2):216-225.
Title: Confocal endomicroscopy diagnostic criteria for early signet-ring cell carcinoma in
hereditary diffuse gastric cancer
Version: 1 Date: 13 Dec 2021
Reviewer:  Cristina Trovato
Reviewer's report:
The manuscript is readable and the Authors well elucidated limitations.
The Authors hypothesized that probe-based confocal laser endomicroscopy (pCLE) might help
diagnose early cancerous lesions in the context of HDGC.
In a previous report (Schueler SA et al, 2021) pCLE alone has low sensitivity for occult cancer
detection in CDH1 variant carriers, but in this paper a systematic approach to identification of
diagnostic criteria has not been used.
In this study the Authors used a strict multi-stage process to identify and validate off-line pCLE
criteria for a diagnosis of signet ring cell carcinoma (SRCC). The criteria identified have 81%
sensitivity and 71% specificity. These do not relate to the signet ring cells per se, but rather
reflect indirect effects on the tissue architecture of the SRCC foci. Real-time validation of these
criteria is required.
Specific Comments:
1) References style requires revision.
2) Reference n. 22 is incomplete, better to cite it as follows: Schueler SA, Gamble LA, Curtin
BF, Ruff SM, Connolly M, Hannah C, et al. Evaluation of confocal laser endomicroscopy for
detection of occult gastric carcinoma in CDH1 variant carriers. J Gastrointest Oncol. 2021
Apr;12(2):216-225.
Please review this paper.
user
Title: Confocal endomicroscopy diagnostic criteria for early signet-ring cell carcinoma in
hereditary diffuse gastric cancer
Version: 1 Date: 13 Dec 2021
Reviewer:  Cristina Trovato
Reviewer's report:
The manuscript is readable and the Authors well elucidated limitations.
The Authors hypothesized that probe-based confocal laser endomicroscopy (pCLE) might help
diagnose early cancerous lesions in the context of HDGC.
In a previous report (Schueler SA et al, 2021) pCLE alone has low sensitivity for occult cancer
detection in CDH1 variant carriers, but in this paper a systematic approach to identification of
diagnostic criteria has not been used.
In this study the Authors used a strict multi-stage process to identify and validate off-line pCLE
criteria for a diagnosis of signet ring cell carcinoma (SRCC). The criteria identified have 81%
sensitivity and 71% specificity. These do not relate to the signet ring cells per se, but rather
reflect indirect effects on the tissue architecture of the SRCC foci. Real-time validation of these
criteria is required.
Specific Comments:
1) References style requires revision.
2) Reference n. 22 is incomplete, better to cite it as follows: Schueler SA, Gamble LA, Curtin
BF, Ruff SM, Connolly M, Hannah C, et al. Evaluation of confocal laser endomicroscopy for
detection of occult gastric carcinoma in CDH1 variant carriers. J Gastrointest Oncol. 2021
Apr;12(2):216-225.
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