Title: Impact of Tumor Type and Size on Macroscopic Tissue Core Retrieval in Endoscopic
Ultrasound-Guided Fine Needle Biopsy for Pancreatic Malignancies
Version: 0 Date: 27 Sep 2024
Reviewer's report:
Dear authors,
Your work is fluid in reading and well-structured in the results.
In the conclusions you assert that the "macroscopic visible core" or more precisely a "sufficient
macroscopic tissue core" (>=4 mm) can positively impact on the histological diagnosis of
adenocarcinoma, especially when the lesion was smaller than 3 cm but not on neuroendocrine
tumor ones.
Furthermore, you hypothesize macroscopic and visible tissue core differs for fibrotic tissue
amount linked to the desmoplastic reaction typical of ductal adenocarcinoma as well as in the
size of the neoplasm.
Although the conclusions and hypotheses are shareable,  I have some doubts about their
transferability into clinical practice. My doubts can be summarized in the following points:
- The retrospective design of the work with the selection of PDAC and NET cases a posteriori;
in particular, as confirmed by you, of PDAC predominantly advanced in symptomatic patients
and on the other hand NET found incidentally with more probability of small lesions.
- the lack of tomographic and/or endoscopic-contrast-enhanced ultrasound techniques nor of
flow analysis capable of orienting towards a specific diagnosis.
- the lack of ROSE in a tertiary center in the differential diagnosis of neoplastic lesions, at least
for selected doubtful cases, is hardly acceptable.
I therefore ask the authors to report and analyze data of pre-biopsy evaluation studies (Tc scan/
US/MRI) useful for the presumptive diagnosis of the target lesions. I also ask to emphasize the
limits of the analysis presented in relation to the underlying selection bias.
Title: Impact of Tumor Type and Size on Macroscopic Tissue Core Retrieval in Endoscopic
Ultrasound-Guided Fine Needle Biopsy for Pancreatic Malignancies
Version: 0 Date: 27 Sep 2024
Reviewer's report:
Dear authors,
Your work is fluid in reading and well-structured in the results.
In the conclusions you assert that the "macroscopic visible core" or more precisely a "sufficient
macroscopic tissue core" (>=4 mm) can positively impact on the histological diagnosis of
adenocarcinoma, especially when the lesion was smaller than 3 cm but not on neuroendocrine
tumor ones.
Furthermore, you hypothesize macroscopic and visible tissue core differs for fibrotic tissue
amount linked to the desmoplastic reaction typical of ductal adenocarcinoma as well as in the
size of the neoplasm.
Although the conclusions and hypotheses are shareable,  I have some doubts about their
transferability into clinical practice. My doubts can be summarized in the following points:
- The retrospective design of the work with the selection of PDAC and NET cases a posteriori;
in particular, as confirmed by you, of PDAC predominantly advanced in symptomatic patients
and on the other hand NET found incidentally with more probability of small lesions.
- the lack of tomographic and/or endoscopic-contrast-enhanced ultrasound techniques nor of
flow analysis capable of orienting towards a specific diagnosis.
- the lack of ROSE in a tertiary center in the differential diagnosis of neoplastic lesions, at least
for selected doubtful cases, is hardly acceptable.
I therefore ask the authors to report and analyze data of pre-biopsy evaluation studies (Tc scan/
US/MRI) useful for the presumptive diagnosis of the target lesions. I also ask to emphasize the
limits of the analysis presented in relation to the underlying selection bias.
Please review this paper.
user
Title: Impact of Tumor Type and Size on Macroscopic Tissue Core Retrieval in Endoscopic
Ultrasound-Guided Fine Needle Biopsy for Pancreatic Malignancies
Version: 0 Date: 27 Sep 2024
Reviewer's report:
Dear authors,
Your work is fluid in reading and well-structured in the results.
In the conclusions you assert that the "macroscopic visible core" or more precisely a "sufficient
macroscopic tissue core" (>=4 mm) can positively impact on the histological diagnosis of
adenocarcinoma, especially when the lesion was smaller than 3 cm but not on neuroendocrine
tumor ones.
Furthermore, you hypothesize macroscopic and visible tissue core differs for fibrotic tissue
amount linked to the desmoplastic reaction typical of ductal adenocarcinoma as well as in the
size of the neoplasm.
Although the conclusions and hypotheses are shareable,  I have some doubts about their
transferability into clinical practice. My doubts can be summarized in the following points:
- The retrospective design of the work with the selection of PDAC and NET cases a posteriori;
in particular, as confirmed by you, of PDAC predominantly advanced in symptomatic patients
and on the other hand NET found incidentally with more probability of small lesions.
- the lack of tomographic and/or endoscopic-contrast-enhanced ultrasound techniques nor of
flow analysis capable of orienting towards a specific diagnosis.
- the lack of ROSE in a tertiary center in the differential diagnosis of neoplastic lesions, at least
for selected doubtful cases, is hardly acceptable.
I therefore ask the authors to report and analyze data of pre-biopsy evaluation studies (Tc scan/
US/MRI) useful for the presumptive diagnosis of the target lesions. I also ask to emphasize the
limits of the analysis presented in relation to the underlying selection bias.
assistant