Reviewer's report
Title:The value of a faecal immunochemical test in colorectal cancer
surveillance: a multi-centre cohort study
Version: 3Date:7 May 2012
Reviewer: Enrique Quintero
Reviewer's report:
1) The author´s reply to the requested information on the individuals undergoing
colonoscopy at the recommended intervals clarifies that up to 63% of these
patients underwent surveillance colonoscopy earlier than the recommended
interval. In relation to this point, the explanation given by the authors (new
paragraph in page 9), for selecting an interval cut-off level of 2 years is very
confusing. The assumption that a surveillance interval of <2 years could be
associated with incomplete adenoma removal or lower quality bowel prep seems
to me incorrect, and is not supported by any evidence. Moreover, these two
circumstances only justify about 30% of colonoscopies performed at inadequate
intervals. Patients in both situations had an incomplete index colonoscopy and
colonoscopy should be repeated before considering the appropriate surveillance
interval. Overall, these patients represented about 30% (n=305) of the whole
series in this study. In fact, multivariate analysis shows that FIT positivity is
associated with short surveillance periods (what does this finding mean? Is it a
consequence of an incomplete previous polypectomy?). In my opinion, it does
not make any sense to perform FIT analysis in these patients. This represent a
major flaw in the methodology of the present study and in my opinion may
influence FIT results. Then, I suggest retrieving these patients from the analysis.
2) This paper is reporting interesting information on the accuracy of FIT for
detecting advanced colorectal neoplasia in a heterogeneous high-risk population,
and this should be the major endpoint of the manuscript. In this regard:
- the title should be modified accordingly, as the paper does not report any valid
conclusion regarding the role of FIT in CRC surveillance. In that sense, I suggest
also to delete the last paragraph of the introduction “These findings nay help to
decide…..and postponed colonoscopy surveillance”-
- The authors mention throughout the manuscript that are evaluating the “test
characteristics of FIT”. It would be more appropriate to say “test accuracy” rather
than “test characteristics”.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Reviewer's report
Title:The value of a faecal immunochemical test in colorectal cancer
surveillance: a multi-centre cohort study
Version: 3Date:7 May 2012
Reviewer: Enrique Quintero
Reviewer's report:
1) The author´s reply to the requested information on the individuals undergoing
colonoscopy at the recommended intervals clarifies that up to 63% of these
patients underwent surveillance colonoscopy earlier than the recommended
interval. In relation to this point, the explanation given by the authors (new
paragraph in page 9), for selecting an interval cut-off level of 2 years is very
confusing. The assumption that a surveillance interval of <2 years could be
associated with incomplete adenoma removal or lower quality bowel prep seems
to me incorrect, and is not supported by any evidence. Moreover, these two
circumstances only justify about 30% of colonoscopies performed at inadequate
intervals. Patients in both situations had an incomplete index colonoscopy and
colonoscopy should be repeated before considering the appropriate surveillance
interval. Overall, these patients represented about 30% (n=305) of the whole
series in this study. In fact, multivariate analysis shows that FIT positivity is
associated with short surveillance periods (what does this finding mean? Is it a
consequence of an incomplete previous polypectomy?). In my opinion, it does
not make any sense to perform FIT analysis in these patients. This represent a
major flaw in the methodology of the present study and in my opinion may
influence FIT results. Then, I suggest retrieving these patients from the analysis.
2) This paper is reporting interesting information on the accuracy of FIT for
detecting advanced colorectal neoplasia in a heterogeneous high-risk population,
and this should be the major endpoint of the manuscript. In this regard:
- the title should be modified accordingly, as the paper does not report any valid
conclusion regarding the role of FIT in CRC surveillance. In that sense, I suggest
also to delete the last paragraph of the introduction “These findings nay help to
decide…..and postponed colonoscopy surveillance”-
- The authors mention throughout the manuscript that are evaluating the “test
characteristics of FIT”. It would be more appropriate to say “test accuracy” rather
than “test characteristics”.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Please review this paper.
user
Reviewer's report
Title:The value of a faecal immunochemical test in colorectal cancer
surveillance: a multi-centre cohort study
Version: 3Date:7 May 2012
Reviewer: Enrique Quintero
Reviewer's report:
1) The author´s reply to the requested information on the individuals undergoing
colonoscopy at the recommended intervals clarifies that up to 63% of these
patients underwent surveillance colonoscopy earlier than the recommended
interval. In relation to this point, the explanation given by the authors (new
paragraph in page 9), for selecting an interval cut-off level of 2 years is very
confusing. The assumption that a surveillance interval of <2 years could be
associated with incomplete adenoma removal or lower quality bowel prep seems
to me incorrect, and is not supported by any evidence. Moreover, these two
circumstances only justify about 30% of colonoscopies performed at inadequate
intervals. Patients in both situations had an incomplete index colonoscopy and
colonoscopy should be repeated before considering the appropriate surveillance
interval. Overall, these patients represented about 30% (n=305) of the whole
series in this study. In fact, multivariate analysis shows that FIT positivity is
associated with short surveillance periods (what does this finding mean? Is it a
consequence of an incomplete previous polypectomy?). In my opinion, it does
not make any sense to perform FIT analysis in these patients. This represent a
major flaw in the methodology of the present study and in my opinion may
influence FIT results. Then, I suggest retrieving these patients from the analysis.
2) This paper is reporting interesting information on the accuracy of FIT for
detecting advanced colorectal neoplasia in a heterogeneous high-risk population,
and this should be the major endpoint of the manuscript. In this regard:
- the title should be modified accordingly, as the paper does not report any valid
conclusion regarding the role of FIT in CRC surveillance. In that sense, I suggest
also to delete the last paragraph of the introduction “These findings nay help to
decide…..and postponed colonoscopy surveillance”-
- The authors mention throughout the manuscript that are evaluating the “test
characteristics of FIT”. It would be more appropriate to say “test accuracy” rather
than “test characteristics”.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
assistant