Title: Immunohistochemical Staining for IMP3 in Patients with Duodenal Papilla Tumors:
Assessment of the Potential for Diagnosing Endoscopic Resectability and Predicting Prognosis
Version: 2 Date: 22 Feb 2021
Reviewer's report:
The authors investigate the accuracy of immunohistochemical staining with IMP3 to determine
the presence or absence of adenocarcinoma in the sphincter of Oddi among biopsy specimens
and resected specimens. The study is interesting and useful in a clinical setting. However, the
manuscript has some major structural flaws and I have a few comments that, if addressed, would
improve the quality of the manuscript:
TITLE: I suggest changing the title, as the sentence “assessing the potential for diagnosing
localized tumor resection (…)” doesn’t make sense. A tumor resection cannot be diagnosed.
ABSTRACT: In the methods section, it is unclear whether the biopsies were from the same
resected specimens. Please specify this.
METHODS:
1) Were the 25 included patients included consecutively in the study?
2) I would suggest drawing a flowchart of the included patients so it will become obvious to
the reader which patients received surgical resection and which received endoscopic resection.
This information could then be omitted in Table 1. Furthermore, I would strongly recommend
moving this information to the results section of the manuscript.
3) It is unclear to the reader whether the biopsies were from the same resected specimens. Please
specify this.
4) How many biopsies did you obtain pr. patient? What was the positive rates and range of the
individual biopsies? (could be provided as supplementary material).
5) How was the tumor-tissue handled after surgical resection/biopsy? If it was fixed in formalin,
how long? Please describe the protocol for gross examination of the tumors. How much tumor
tissue were evaluated by IHC for IMP3 per specimen?
6) Did you use other IHC to subclassify the tumors?
7) Did you detect any difference in the expression-pattern of IMP3 between the superficial and
deeper tumor areas of the resected specimens? If so, this should be included in the results-section.
RESULTS: Some of the data regarding median IMP3 positive rates are redundant as it is already
included in Table 1. I would suggest summarizing these findings in a narrative way, for example
mentioning the groups with the highest and lowest values.
DISCUSSION: The described IMP3-pattern of the different subtypes should be placed in the
“results”-section of the manuscript.
FIGURE 1: I would suggest removing the gridlines for at better visual impression.
FIGURE 2:  Please provide high resolution images with adjusted white balance. A panel “D”
with a micrograph of a biopsy should be provided.
FIGURE 4: Please provide a number at risk table for the Kaplan-Meier curve. I would suggest
removing the gridlines for a better visual impression of the graph.
TABLE 1: Please remove colours in accordance with the author guidelines. Column 1 and 2
should be revised. For example, “IMP3 positive cells (%) of resected specimen” and “Rate of
IMP3 positive cell rate over 10%” belong to the same column.
Please proofread the manuscript and correct typos.
Title: Immunohistochemical Staining for IMP3 in Patients with Duodenal Papilla Tumors:
Assessment of the Potential for Diagnosing Endoscopic Resectability and Predicting Prognosis
Version: 2 Date: 22 Feb 2021
Reviewer's report:
The authors investigate the accuracy of immunohistochemical staining with IMP3 to determine
the presence or absence of adenocarcinoma in the sphincter of Oddi among biopsy specimens
and resected specimens. The study is interesting and useful in a clinical setting. However, the
manuscript has some major structural flaws and I have a few comments that, if addressed, would
improve the quality of the manuscript:
TITLE: I suggest changing the title, as the sentence “assessing the potential for diagnosing
localized tumor resection (…)” doesn’t make sense. A tumor resection cannot be diagnosed.
ABSTRACT: In the methods section, it is unclear whether the biopsies were from the same
resected specimens. Please specify this.
METHODS:
1) Were the 25 included patients included consecutively in the study?
2) I would suggest drawing a flowchart of the included patients so it will become obvious to
the reader which patients received surgical resection and which received endoscopic resection.
This information could then be omitted in Table 1. Furthermore, I would strongly recommend
moving this information to the results section of the manuscript.
3) It is unclear to the reader whether the biopsies were from the same resected specimens. Please
specify this.
4) How many biopsies did you obtain pr. patient? What was the positive rates and range of the
individual biopsies? (could be provided as supplementary material).
5) How was the tumor-tissue handled after surgical resection/biopsy? If it was fixed in formalin,
how long? Please describe the protocol for gross examination of the tumors. How much tumor
tissue were evaluated by IHC for IMP3 per specimen?
6) Did you use other IHC to subclassify the tumors?
7) Did you detect any difference in the expression-pattern of IMP3 between the superficial and
deeper tumor areas of the resected specimens? If so, this should be included in the results-section.
RESULTS: Some of the data regarding median IMP3 positive rates are redundant as it is already
included in Table 1. I would suggest summarizing these findings in a narrative way, for example
mentioning the groups with the highest and lowest values.
DISCUSSION: The described IMP3-pattern of the different subtypes should be placed in the
“results”-section of the manuscript.
FIGURE 1: I would suggest removing the gridlines for at better visual impression.
FIGURE 2:  Please provide high resolution images with adjusted white balance. A panel “D”
with a micrograph of a biopsy should be provided.
FIGURE 4: Please provide a number at risk table for the Kaplan-Meier curve. I would suggest
removing the gridlines for a better visual impression of the graph.
TABLE 1: Please remove colours in accordance with the author guidelines. Column 1 and 2
should be revised. For example, “IMP3 positive cells (%) of resected specimen” and “Rate of
IMP3 positive cell rate over 10%” belong to the same column.
Please proofread the manuscript and correct typos.
Please review this paper.
user
Title: Immunohistochemical Staining for IMP3 in Patients with Duodenal Papilla Tumors:
Assessment of the Potential for Diagnosing Endoscopic Resectability and Predicting Prognosis
Version: 2 Date: 22 Feb 2021
Reviewer's report:
The authors investigate the accuracy of immunohistochemical staining with IMP3 to determine
the presence or absence of adenocarcinoma in the sphincter of Oddi among biopsy specimens
and resected specimens. The study is interesting and useful in a clinical setting. However, the
manuscript has some major structural flaws and I have a few comments that, if addressed, would
improve the quality of the manuscript:
TITLE: I suggest changing the title, as the sentence “assessing the potential for diagnosing
localized tumor resection (…)” doesn’t make sense. A tumor resection cannot be diagnosed.
ABSTRACT: In the methods section, it is unclear whether the biopsies were from the same
resected specimens. Please specify this.
METHODS:
1) Were the 25 included patients included consecutively in the study?
2) I would suggest drawing a flowchart of the included patients so it will become obvious to
the reader which patients received surgical resection and which received endoscopic resection.
This information could then be omitted in Table 1. Furthermore, I would strongly recommend
moving this information to the results section of the manuscript.
3) It is unclear to the reader whether the biopsies were from the same resected specimens. Please
specify this.
4) How many biopsies did you obtain pr. patient? What was the positive rates and range of the
individual biopsies? (could be provided as supplementary material).
5) How was the tumor-tissue handled after surgical resection/biopsy? If it was fixed in formalin,
how long? Please describe the protocol for gross examination of the tumors. How much tumor
tissue were evaluated by IHC for IMP3 per specimen?
6) Did you use other IHC to subclassify the tumors?
7) Did you detect any difference in the expression-pattern of IMP3 between the superficial and
deeper tumor areas of the resected specimens? If so, this should be included in the results-section.
RESULTS: Some of the data regarding median IMP3 positive rates are redundant as it is already
included in Table 1. I would suggest summarizing these findings in a narrative way, for example
mentioning the groups with the highest and lowest values.
DISCUSSION: The described IMP3-pattern of the different subtypes should be placed in the
“results”-section of the manuscript.
FIGURE 1: I would suggest removing the gridlines for at better visual impression.
FIGURE 2:  Please provide high resolution images with adjusted white balance. A panel “D”
with a micrograph of a biopsy should be provided.
FIGURE 4: Please provide a number at risk table for the Kaplan-Meier curve. I would suggest
removing the gridlines for a better visual impression of the graph.
TABLE 1: Please remove colours in accordance with the author guidelines. Column 1 and 2
should be revised. For example, “IMP3 positive cells (%) of resected specimen” and “Rate of
IMP3 positive cell rate over 10%” belong to the same column.
Please proofread the manuscript and correct typos.
assistant