Reviewer’ s report
Title: The efficacy of pancreatic juice cytology with liquid-based cytology for evaluating
malignancy in patients with intraductal papillary mucinous neoplasm
Version: 2Date: 06 Jun 2020
Reviewer's report:
In this study, authors evaluated the efficacy of LBC for IPMN, which revealed higher diagnostic
accuracy compared with smear method.This paper offers novelty because there have been no previous reports about LBC for IPMN andmay provide clinical impacts for considering future indication of ERCP-based cytology.
Major:
The authors showed the evaluation of the factors contributing to the accuracy of a malignantIPMN diagnosis (Table 3). I could not find out whether this analysis was performed by the patientsof malignant IPMN (43 patients) or by all the patients (90 patients) because there was nodescription of patient number or the ratio of malignancy for this analysis in RESULTS (P11-12,Evaluating the factors contributing to the accuracy of a malignant IPMN diagnosis) and Table 3.I think that it may not be suitable for the evaluation of the factors contributing to the accuracy of amalignant IPMN diagnosis if the authors performed this analysis by all the study patients (n=90)because the sensitivity and the specificity was remarkably different (sensitivity 28%; specificity98% in Table 2).
1.The authors wrote that they used a 0.025-inch guidewire (VisiGlide2; Olympus), which was
available in Japan from 2014. On the other hand, the study period was from 2003. The authors
should re-check the description of all the devices for ERCP procedures and collecting pancreatic
juice.
2.Figure 2 shows the representative findings of the smear and LBC methods.
Figure 2 Legend indicates "PJC in patients with malignant IPMN: (A) Smear method. (B) LBC.H&E, hematoxylin and eosin staining; pancreatic juice cytology; LBC, liquid-based cytology".I wonder whether the sample of figure 2B was really stained by HE (Was it stained byPapanicolaou Staining?). I also wonder whether the sample of figure 2A was really stained by HEbecause HE is mainly used for histology. Was figure 2A stained with Diff-Quick or May-giemsa?Please re-check the condition of these pictures.I cannot find out the clear differences of Figure 2A and Figure 2B. Moreover, the picture of Figure2B was not so clear. This paper tried to show the superiority of LBC. Therefore, Figure 2 wascrucial to your argument.I recommend the authors to consult these points with pathologists because they are not included inthe author list.
3.The authors should discuss the future indication of ERCP-based cytology for surgical
candidates. The sensitivity with LBC was not high enough (40% in Table 2), while the percentage
of PEP was 12.5%, which may result in the cancel or the delay of surgery.
Minor:
1.P8. METHOD: Was saline washing performed in all cases? Is there any difference between thecases with smear method and those with LBC?2.P9. METHOD: Please add brief explanation of Cotton criteria.3.P11. Please explain the method of a serial pancreatic juice aspiration cytological examination(SPACE) in METHODS section.4.P11. Patient characteristics: "A SPACE was performed more frequently in the LBC group than inthe smear method group (Table 1)."→Please describe the percentage and the ratio of patients in the
manuscript of RESULTS.
5.Please describe the comparison between the cases with SPACE and those without SPACE interms of diagnostic ability and complication in the section of RESULTS. The authors mentioneddiagnostic ability of SPACE only in DISCUSSION (P18).6.P12. Evaluating the factors contributing to the accuracy of a malignant IPMN diagnosis: "all hadP < 0.2." →What does this sentence mean?
7.P13-14. Post-ERCP adverse events: Was there any case where surgery was cancelled or delayedbecause of PEP? Was there any case of other adverse events?8.Table 3: Please describe detailed number of patients and the ratio of malignancy in univariateanalysis.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Unable to assessAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that 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 received 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.
I declare that I have no competing interests.
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 this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. 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: The efficacy of pancreatic juice cytology with liquid-based cytology for evaluating
malignancy in patients with intraductal papillary mucinous neoplasm
Version: 2Date: 06 Jun 2020
Reviewer's report:
In this study, authors evaluated the efficacy of LBC for IPMN, which revealed higher diagnostic
accuracy compared with smear method.This paper offers novelty because there have been no previous reports about LBC for IPMN andmay provide clinical impacts for considering future indication of ERCP-based cytology.
Major:
The authors showed the evaluation of the factors contributing to the accuracy of a malignantIPMN diagnosis (Table 3). I could not find out whether this analysis was performed by the patientsof malignant IPMN (43 patients) or by all the patients (90 patients) because there was nodescription of patient number or the ratio of malignancy for this analysis in RESULTS (P11-12,Evaluating the factors contributing to the accuracy of a malignant IPMN diagnosis) and Table 3.I think that it may not be suitable for the evaluation of the factors contributing to the accuracy of amalignant IPMN diagnosis if the authors performed this analysis by all the study patients (n=90)because the sensitivity and the specificity was remarkably different (sensitivity 28%; specificity98% in Table 2).
1.The authors wrote that they used a 0.025-inch guidewire (VisiGlide2; Olympus), which was
available in Japan from 2014. On the other hand, the study period was from 2003. The authors
should re-check the description of all the devices for ERCP procedures and collecting pancreatic
juice.
2.Figure 2 shows the representative findings of the smear and LBC methods.
Figure 2 Legend indicates "PJC in patients with malignant IPMN: (A) Smear method. (B) LBC.H&E, hematoxylin and eosin staining; pancreatic juice cytology; LBC, liquid-based cytology".I wonder whether the sample of figure 2B was really stained by HE (Was it stained byPapanicolaou Staining?). I also wonder whether the sample of figure 2A was really stained by HEbecause HE is mainly used for histology. Was figure 2A stained with Diff-Quick or May-giemsa?Please re-check the condition of these pictures.I cannot find out the clear differences of Figure 2A and Figure 2B. Moreover, the picture of Figure2B was not so clear. This paper tried to show the superiority of LBC. Therefore, Figure 2 wascrucial to your argument.I recommend the authors to consult these points with pathologists because they are not included inthe author list.
3.The authors should discuss the future indication of ERCP-based cytology for surgical
candidates. The sensitivity with LBC was not high enough (40% in Table 2), while the percentage
of PEP was 12.5%, which may result in the cancel or the delay of surgery.
Minor:
1.P8. METHOD: Was saline washing performed in all cases? Is there any difference between thecases with smear method and those with LBC?2.P9. METHOD: Please add brief explanation of Cotton criteria.3.P11. Please explain the method of a serial pancreatic juice aspiration cytological examination(SPACE) in METHODS section.4.P11. Patient characteristics: "A SPACE was performed more frequently in the LBC group than inthe smear method group (Table 1)."→Please describe the percentage and the ratio of patients in the
manuscript of RESULTS.
5.Please describe the comparison between the cases with SPACE and those without SPACE interms of diagnostic ability and complication in the section of RESULTS. The authors mentioneddiagnostic ability of SPACE only in DISCUSSION (P18).6.P12. Evaluating the factors contributing to the accuracy of a malignant IPMN diagnosis: "all hadP < 0.2." →What does this sentence mean?
7.P13-14. Post-ERCP adverse events: Was there any case where surgery was cancelled or delayedbecause of PEP? Was there any case of other adverse events?8.Table 3: Please describe detailed number of patients and the ratio of malignancy in univariateanalysis.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Unable to assessAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that 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 received 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.
I declare that I have no competing interests.
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 this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. 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: The efficacy of pancreatic juice cytology with liquid-based cytology for evaluating
malignancy in patients with intraductal papillary mucinous neoplasm
Version: 2Date: 06 Jun 2020
Reviewer's report:
In this study, authors evaluated the efficacy of LBC for IPMN, which revealed higher diagnostic
accuracy compared with smear method.This paper offers novelty because there have been no previous reports about LBC for IPMN andmay provide clinical impacts for considering future indication of ERCP-based cytology.
Major:
The authors showed the evaluation of the factors contributing to the accuracy of a malignantIPMN diagnosis (Table 3). I could not find out whether this analysis was performed by the patientsof malignant IPMN (43 patients) or by all the patients (90 patients) because there was nodescription of patient number or the ratio of malignancy for this analysis in RESULTS (P11-12,Evaluating the factors contributing to the accuracy of a malignant IPMN diagnosis) and Table 3.I think that it may not be suitable for the evaluation of the factors contributing to the accuracy of amalignant IPMN diagnosis if the authors performed this analysis by all the study patients (n=90)because the sensitivity and the specificity was remarkably different (sensitivity 28%; specificity98% in Table 2).
1.The authors wrote that they used a 0.025-inch guidewire (VisiGlide2; Olympus), which was
available in Japan from 2014. On the other hand, the study period was from 2003. The authors
should re-check the description of all the devices for ERCP procedures and collecting pancreatic
juice.
2.Figure 2 shows the representative findings of the smear and LBC methods.
Figure 2 Legend indicates "PJC in patients with malignant IPMN: (A) Smear method. (B) LBC.H&E, hematoxylin and eosin staining; pancreatic juice cytology; LBC, liquid-based cytology".I wonder whether the sample of figure 2B was really stained by HE (Was it stained byPapanicolaou Staining?). I also wonder whether the sample of figure 2A was really stained by HEbecause HE is mainly used for histology. Was figure 2A stained with Diff-Quick or May-giemsa?Please re-check the condition of these pictures.I cannot find out the clear differences of Figure 2A and Figure 2B. Moreover, the picture of Figure2B was not so clear. This paper tried to show the superiority of LBC. Therefore, Figure 2 wascrucial to your argument.I recommend the authors to consult these points with pathologists because they are not included inthe author list.
3.The authors should discuss the future indication of ERCP-based cytology for surgical
candidates. The sensitivity with LBC was not high enough (40% in Table 2), while the percentage
of PEP was 12.5%, which may result in the cancel or the delay of surgery.
Minor:
1.P8. METHOD: Was saline washing performed in all cases? Is there any difference between thecases with smear method and those with LBC?2.P9. METHOD: Please add brief explanation of Cotton criteria.3.P11. Please explain the method of a serial pancreatic juice aspiration cytological examination(SPACE) in METHODS section.4.P11. Patient characteristics: "A SPACE was performed more frequently in the LBC group than inthe smear method group (Table 1)."→Please describe the percentage and the ratio of patients in the
manuscript of RESULTS.
5.Please describe the comparison between the cases with SPACE and those without SPACE interms of diagnostic ability and complication in the section of RESULTS. The authors mentioneddiagnostic ability of SPACE only in DISCUSSION (P18).6.P12. Evaluating the factors contributing to the accuracy of a malignant IPMN diagnosis: "all hadP < 0.2." →What does this sentence mean?
7.P13-14. Post-ERCP adverse events: Was there any case where surgery was cancelled or delayedbecause of PEP? Was there any case of other adverse events?8.Table 3: Please describe detailed number of patients and the ratio of malignancy in univariateanalysis.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
YesAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Unable to assessAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that 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 received 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.
I declare that I have no competing interests.
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 this manu-script is accepted for publication. Any comments that I do not wish to be included in the publishedreport have been included as confidential comments to the editor, which will not be published.Ifyou are not happy for us to publish this report, please contact the editorial office before completingthe review.If you wish, you can include your name in your published report. Please note you mustdecide whether to include your name at the start of the process and confirm this decision wheneverprompted. 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