Reviewer’s report
Title: 
Effectiveness of introducing a 20-gauge core biopsy needle with a core
trap in EUS-FNA/B for diagnosing pancreatic cancer
Version: 
0 
Date: 
29 Sep 2020
Reviewer: 
John Leeds
Reviewer's report:
The authors describe the use of several needle types used for the acquisition of
tissue in patients undergoing EUS for pancreatic masses and compare the
characteristics of the samples and diagnostic accuracy. This is an interesting
study but has some issues which need to be addressed:
1. The main issue with this study is its retrospective design. Patients were not
randomised to a needle selection and there was no strict protocol for number of
passes into the lesion. This needs to be adequately addressed in the discussion.
2. There was no blinding of the pathologists or endoscopists as to which needle
was selected.
3. The numbers in each group are variable with the total number in the acquire
group being very low at 12 making comparison with this needle type
problematic.
4. The needles were available at different time periods. This is very important as
there may be a significant time factor where the endoscopists need to become
comfortable with a new needle as well as they had more experience as time went
on. It would be interesting to know whether there were any differences in
accuracy if the first 50 uses of each needle were compared.
5. No data is given about whether the sampling was transduodenal or
transgastric. A presentation of the comparisons of each locations would be
helpful.
6. The authors used "suspected" cancer as a positive outcome. This is no longer
acceptable as this is insufficient to be accepted for chemotherapy or entry into
clinical trials. The authors should reanalyse the results looking at "definite"
cancers also.
7. No information is given about final diagnoses in the whole cohort e.g.
percentage with pancreatic cancer, chronic pancreatitis, neuroendocrine tumours
etc.
8. There were some significant differences between the groups at the outset
which requires some commentary. The tumour size and stroke length were
significantly bigger for the PC groups as was the number of passes. Number of
passes has been shown to improve diagnostic yield alone. Once could argue
therefore that the AC group obtained just as good results but in more difficult
circumstances and in less time so perhaps this is a better needle?
9. More information is needed about the pathologists experience as they are the
ones that really matter. Were they cytopathologists or histopathologists or both.
Was there double reporting of specimens as is now common?
10. Very little comment is made about the data concerning other FNB needles for
which there are now several RCT's showing improvement over FNA needles.
Similarly, the Procore needles have been shown to be no better than an FNA
needle.
11 .The introduction feels very long and could be shortened - similarly with the
discussion.
12. The statistical reporting in the tables does not make it clear where the
differences lie e.g. the p value is <0.01 but is this for all 3 groups or just between
two of the three.
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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 this manuscript, 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 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 editorial
office before completing the review.
If you wish, you can include your name in your published 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 publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Effectiveness of introducing a 20-gauge core biopsy needle with a core
trap in EUS-FNA/B for diagnosing pancreatic cancer
Version: 
0 
Date: 
29 Sep 2020
Reviewer: 
John Leeds
Reviewer's report:
The authors describe the use of several needle types used for the acquisition of
tissue in patients undergoing EUS for pancreatic masses and compare the
characteristics of the samples and diagnostic accuracy. This is an interesting
study but has some issues which need to be addressed:
1. The main issue with this study is its retrospective design. Patients were not
randomised to a needle selection and there was no strict protocol for number of
passes into the lesion. This needs to be adequately addressed in the discussion.
2. There was no blinding of the pathologists or endoscopists as to which needle
was selected.
3. The numbers in each group are variable with the total number in the acquire
group being very low at 12 making comparison with this needle type
problematic.
4. The needles were available at different time periods. This is very important as
there may be a significant time factor where the endoscopists need to become
comfortable with a new needle as well as they had more experience as time went
on. It would be interesting to know whether there were any differences in
accuracy if the first 50 uses of each needle were compared.
5. No data is given about whether the sampling was transduodenal or
transgastric. A presentation of the comparisons of each locations would be
helpful.
6. The authors used "suspected" cancer as a positive outcome. This is no longer
acceptable as this is insufficient to be accepted for chemotherapy or entry into
clinical trials. The authors should reanalyse the results looking at "definite"
cancers also.
7. No information is given about final diagnoses in the whole cohort e.g.
percentage with pancreatic cancer, chronic pancreatitis, neuroendocrine tumours
etc.
8. There were some significant differences between the groups at the outset
which requires some commentary. The tumour size and stroke length were
significantly bigger for the PC groups as was the number of passes. Number of
passes has been shown to improve diagnostic yield alone. Once could argue
therefore that the AC group obtained just as good results but in more difficult
circumstances and in less time so perhaps this is a better needle?
9. More information is needed about the pathologists experience as they are the
ones that really matter. Were they cytopathologists or histopathologists or both.
Was there double reporting of specimens as is now common?
10. Very little comment is made about the data concerning other FNB needles for
which there are now several RCT's showing improvement over FNA needles.
Similarly, the Procore needles have been shown to be no better than an FNA
needle.
11 .The introduction feels very long and could be shortened - similarly with the
discussion.
12. The statistical reporting in the tables does not make it clear where the
differences lie e.g. the p value is <0.01 but is this for all 3 groups or just between
two of the three.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
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 this manuscript, 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 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 editorial
office before completing the review.
If you wish, you can include your name in your published 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 publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Effectiveness of introducing a 20-gauge core biopsy needle with a core
trap in EUS-FNA/B for diagnosing pancreatic cancer
Version: 
0 
Date: 
29 Sep 2020
Reviewer: 
John Leeds
Reviewer's report:
The authors describe the use of several needle types used for the acquisition of
tissue in patients undergoing EUS for pancreatic masses and compare the
characteristics of the samples and diagnostic accuracy. This is an interesting
study but has some issues which need to be addressed:
1. The main issue with this study is its retrospective design. Patients were not
randomised to a needle selection and there was no strict protocol for number of
passes into the lesion. This needs to be adequately addressed in the discussion.
2. There was no blinding of the pathologists or endoscopists as to which needle
was selected.
3. The numbers in each group are variable with the total number in the acquire
group being very low at 12 making comparison with this needle type
problematic.
4. The needles were available at different time periods. This is very important as
there may be a significant time factor where the endoscopists need to become
comfortable with a new needle as well as they had more experience as time went
on. It would be interesting to know whether there were any differences in
accuracy if the first 50 uses of each needle were compared.
5. No data is given about whether the sampling was transduodenal or
transgastric. A presentation of the comparisons of each locations would be
helpful.
6. The authors used "suspected" cancer as a positive outcome. This is no longer
acceptable as this is insufficient to be accepted for chemotherapy or entry into
clinical trials. The authors should reanalyse the results looking at "definite"
cancers also.
7. No information is given about final diagnoses in the whole cohort e.g.
percentage with pancreatic cancer, chronic pancreatitis, neuroendocrine tumours
etc.
8. There were some significant differences between the groups at the outset
which requires some commentary. The tumour size and stroke length were
significantly bigger for the PC groups as was the number of passes. Number of
passes has been shown to improve diagnostic yield alone. Once could argue
therefore that the AC group obtained just as good results but in more difficult
circumstances and in less time so perhaps this is a better needle?
9. More information is needed about the pathologists experience as they are the
ones that really matter. Were they cytopathologists or histopathologists or both.
Was there double reporting of specimens as is now common?
10. Very little comment is made about the data concerning other FNB needles for
which there are now several RCT's showing improvement over FNA needles.
Similarly, the Procore needles have been shown to be no better than an FNA
needle.
11 .The introduction feels very long and could be shortened - similarly with the
discussion.
12. The statistical reporting in the tables does not make it clear where the
differences lie e.g. the p value is <0.01 but is this for all 3 groups or just between
two of the three.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
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 this manuscript, 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 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 editorial
office before completing the review.
If you wish, you can include your name in your published 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 publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant