Reviewer ’s report  
 
Title: Diagnostic effect of shear wa ve elastography imaging for differentiation of malignant liver 
lesions: a meta -analysis  
 
Version: 0 Date: 29 Jan 2019  
 
Reviewer: Ming -Jen Chen  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comments to the authors.  
 
Comments to the authors:  
1. In the selection criteria, there is a diversity of reference standard and unclear study designs 
of included studies might contribute clinical heterogeneities and the authors did not take it 
seriously.   
 
2. The baseline adjacent liver stiffness might int erfere with the SWE of the tumors, and the 
authors did not deal with the data seriously. Moreover, the diagnostic flow and timing are 
unclear.  
 
3. The quality review of the studies is poorly conducted with hidden information including the 
judgement of the degree of risk of bias. Besides, there is a high portion of the measurement 
failure among the included studies (from 1.2% to 26.3%), it is not appropriate to pool the 
summarize effects without taking in consideration of high attrition rate. It might not be  able 
to pool the biased data and give a simple conclusion. Moreover, the final the application 
might be an overstatement.  
Are the methods appropriate and well described?  
If not, please specify what is  required in your comments to the authors.  
 
Yes 
 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, p lease explain in your comments to the authors.  
 
No 
 
Are 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 furt her 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 publi cation 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 curr ently 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 inter ests' 
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named repo rt 
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Diagnostic effect of shear wa ve elastography imaging for differentiation of malignant liver 
lesions: a meta -analysis  
 
Version: 0 Date: 29 Jan 2019  
 
Reviewer: Ming -Jen Chen  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comments to the authors.  
 
Comments to the authors:  
1. In the selection criteria, there is a diversity of reference standard and unclear study designs 
of included studies might contribute clinical heterogeneities and the authors did not take it 
seriously.   
 
2. The baseline adjacent liver stiffness might int erfere with the SWE of the tumors, and the 
authors did not deal with the data seriously. Moreover, the diagnostic flow and timing are 
unclear.  
 
3. The quality review of the studies is poorly conducted with hidden information including the 
judgement of the degree of risk of bias. Besides, there is a high portion of the measurement 
failure among the included studies (from 1.2% to 26.3%), it is not appropriate to pool the 
summarize effects without taking in consideration of high attrition rate. It might not be  able 
to pool the biased data and give a simple conclusion. Moreover, the final the application 
might be an overstatement.  
Are the methods appropriate and well described?  
If not, please specify what is  required in your comments to the authors.  
 
Yes 
 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, p lease explain in your comments to the authors.  
 
No 
 
Are 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 furt her 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 publi cation 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 curr ently 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 inter ests' 
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named repo rt 
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Diagnostic effect of shear wa ve elastography imaging for differentiation of malignant liver 
lesions: a meta -analysis  
 
Version: 0 Date: 29 Jan 2019  
 
Reviewer: Ming -Jen Chen  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
Please overwrite this text when adding your comments to the authors.  
 
Comments to the authors:  
1. In the selection criteria, there is a diversity of reference standard and unclear study designs 
of included studies might contribute clinical heterogeneities and the authors did not take it 
seriously.   
 
2. The baseline adjacent liver stiffness might int erfere with the SWE of the tumors, and the 
authors did not deal with the data seriously. Moreover, the diagnostic flow and timing are 
unclear.  
 
3. The quality review of the studies is poorly conducted with hidden information including the 
judgement of the degree of risk of bias. Besides, there is a high portion of the measurement 
failure among the included studies (from 1.2% to 26.3%), it is not appropriate to pool the 
summarize effects without taking in consideration of high attrition rate. It might not be  able 
to pool the biased data and give a simple conclusion. Moreover, the final the application 
might be an overstatement.  
Are the methods appropriate and well described?  
If not, please specify what is  required in your comments to the authors.  
 
Yes 
 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, p lease explain in your comments to the authors.  
 
No 
 
Are 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 furt her 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 publi cation 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 curr ently 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 inter ests' 
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named repo rt 
including any attachments I upload will be posted on the website along with the authors'  
responses. 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/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant